Active NPI
Ellis Nursing Home, Inc.
- Skilled Nursing Facility
- Norwood, MA
National Provider Identifier
1790772192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- ELLIS NURSING HOME, INC.
- Practice address
- 135 Ellis Ave
Norwood, MA 02062-3946 - Phone
- (781) 762-6880
- NPI assigned
- Sep 30, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Danielle A Federico
- Title
- Business Manger
- Phone
- (781) 237-8503
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 0793 | MA | |
| Rehabilitation Clinic/Center | 261QR0400X | |||
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
135 Ellis Ave
Norwood, MA 02062-3946
Mailing address
135 Ellis Ave
Norwood, MA 02062-3946
Phone (781) 762-6880
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0908029 | Medicaid | MA | |
| 2222521101 | Other | BCBS | |
| 903249 | Other | HDHC |
National Provider Directory
National Provider Directory- Tax ID family
- Ellis Nursing Home Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Norwood, MA
- NPI 1700872967
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128038400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1516147200000",
"number": "1790772192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 ELLIS AVE",
"city": "NORWOOD",
"state": "MA",
"postal_code": "020623946",
"telephone_number": "781-762-6880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 ELLIS AVE",
"city": "NORWOOD",
"state": "MA",
"postal_code": "020623946",
"telephone_number": "781-762-6880"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELLIS NURSING HOME, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-30",
"last_updated": "2018-01-17",
"status": "A",
"authorized_official_last_name": "FEDERICO",
"authorized_official_first_name": "DANIELLE",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "BUSINESS MANGER",
"authorized_official_telephone_number": "781-237-8503",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine, Geriatric Medicine",
"state": "MA",
"license": "0793",
"primary": false
},
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": null,
"license": null,
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0908029",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "2222521101",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HDHC",
"identifier": "903249",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Norwood, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.