Provider Demographics
NPI:1699762898
Name:BERKELEY RETIREMENT HOME
Entity type:Organization
Organization Name:BERKELEY RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-682-1614
Mailing Address - Street 1:150 BERKELEY STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-1224
Mailing Address - Country:US
Mailing Address - Phone:978-682-1614
Mailing Address - Fax:978-686-7170
Practice Address - Street 1:150 BERKELEY STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-1224
Practice Address - Country:US
Practice Address - Phone:978-682-1614
Practice Address - Fax:978-686-7170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA871314000000X
MA0802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0910678Medicaid
MA110025926AMedicaid
MA0910678Medicaid