Basic Information
| Provider Information | |||||||||
| NPI: | 1619086881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEWISH NURSING HOME OF WESTERN MASS., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 CONVERSE ST | ||||||||
| Address2: | |||||||||
| City: | LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011061719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135673949 | ||||||||
| FaxNumber: | 4135670175 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 CONVERSE ST | ||||||||
| Address2: | |||||||||
| City: | LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011061719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135673949 | ||||||||
| FaxNumber: | 4135670175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DYBICK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4135673949 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0722 | MA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0920444 | 05 | MA | MEDICAID |