1750486106 NPI number — CHARLES RIVER COMMUNITY HEALTH, INC

Table of content: (NPI 1750486106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750486106 NPI number — CHARLES RIVER COMMUNITY HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES RIVER COMMUNITY HEALTH, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750486106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 WESTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-693-3800
Provider Business Mailing Address Fax Number:
617-987-8222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 FOUNDRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02453-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-783-0500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNE
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
617-205-1511

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  4157 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2227002110 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1320882 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W20419 . This is a "BCBS - OPTOMETRY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 903699 . This is a "TUFTS HEALTH PLAN - MH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M12043 . This is a "BCBS MEDICAL/PODIATRY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 686893 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110024306T , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 682536 . This is a "TUFTS HEALTH PLAN - MED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com