Broad Reach of Chatham Inc.
Organization Active NPI Skilled Nursing Facility · N Chatham, MA
NPI 1497748735 · NPPES record last updated Mar 12, 2013
Key facts
- NPI
- 1497748735
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 0884 (MA)
- Legal business name
- BROAD REACH OF CHATHAM INC.
- Practice address
- 390 Orleans Rd
N Chatham, MA 02650-1154 - Phone
- (508) 945-4611
- Fax
- (508) 945-2245
- NPI assigned
- Aug 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. William J Bogdanovich, CNHA
- Title
- President/Ceo
- Phone
- (508) 945-4611
Owners & managing parties with NPI records 1
-
Eric Arne Weber, MD
Corporate family (same tax ID) 3
Practitioners 3
-
Mita Gupta, M.D.
-
Eric Arne Weber, MD
Affiliated clinicians 21
-
Hannah Deignan, APRN
-
Mark K Durfee, MD
-
Daniel R Gorin, MD
-
Scott M. Graham, DO
-
Mita Gupta, M.D.
-
Evan Llewellyn Guthrie, M.D.
-
Tara Hart, NP
-
Katelyn Hobill, PA-C
-
Jennifer Buchanan Nalepinski, DNP, FNP
-
R. Scott Oliver, MD
-
Leonard Remia, M.D.
-
Shannon Rex, PA
-
Emily Jean Szemreylo, PAC
-
Eric Arne Weber, MD
-
Kevin William Dwyer, M.D.
-
Argilla R George, MD
-
Heather Marie Wilson, APRN, MA
Medicare Care Compare: Nursing home
- Listed as
- Liberty Commons
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Feb 2, 1989
- Medicare certification status
- Active
- Certified beds
- 132 · 126.5 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Skilled nursing facility certification: CCN 225330
- Legal name
- BROAD REACH OF CHATHAM INC
- Doing business as
- LIBERTY COMMONS NURSING & REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 2, 1989
- Last certification
- Sep 11, 2024
- Beds
- 132
- Ownership / control type
- Corporation
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 390 Orleans Road
North Chatham, MA 02650-1154 - Nursing home name
- LIBERTY COMMONS
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Jason Lavallee |
Operational/Managerial Control |
Feb 1, 2022 | 100% |
| Adp of the SNF | Feb 1, 2022 | ||
| Christopher Jones |
Operational/Managerial Control |
Jan 1, 2022 | 100% |
| Donna Lahaie |
Operational/Managerial Control |
Jan 7, 2021 | 100% |
| |
Adp of the SNF | Jun 18, 2023 | |
| |
Adp of the SNF | Jul 27, 1996 | |
| |
Adp of the SNF | Apr 12, 2025 | |
| |
Adp of the SNF | Apr 12, 2025 | |
| |
Adp of the SNF | Jan 1, 2025 | |
| William J Bogdanovich |
5% Or Greater Direct Ownership Interest |
Nov 12, 2012 | 100% |
| Corporate Officer |
Nov 9, 2012 | 100% | |
| Corporate Director | Dec 12, 2005 | ||
| Operational/Managerial Control | Feb 1, 1987 | ||
| Managing Control - Governing Body |
Nov 9, 2012 | ||
| Adp of the SNF | Feb 1, 1987 | ||
| |
Adp of the SNF | May 21, 2025 | |
| Eric a Weber |
Operational/Managerial Control |
Jun 28, 2004 | |
| Adp of the SNF | Feb 6, 2022 | ||
| |
Adp of the SNF | Jun 18, 2018 | |
| |
Adp of the SNF | May 22, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031107000505 | MA | Part a Provider - Skilled Nursing Facility | 0648183459 | Practice locations: North Chatham, MA |
National Provider Directory
- Tax ID family
- Broad Reach of Chatham Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0884 | MA | Yes |
Addresses
Primary practice location
390 Orleans Rd
N Chatham, MA 02650-1154
Mailing address
390 Orleans Rd
N Chatham, MA 02650-1154
Phone (508) 945-4611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0922935 | Medicaid | MA |
Other names
- Liberty Commons Nursing & Rehabilitation Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.