1760433700 NPI number — THE FAMILY CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760433700 NPI number — THE FAMILY CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FAMILY CENTER, 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:
1760433700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
366 SOMERVILLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02143-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-628-8815
Provider Business Mailing Address Fax Number:
617-625-2351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
366 SOMERVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02143-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-628-8815
Provider Business Practice Location Address Fax Number:
617-625-2351
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VINES
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
617-628-8815

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  4390 , 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: 1310984 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99612301 . This is a "NEWTORK HLTH PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003580 . This is a "NEIGHBORHOOD HLTH PLAN #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18526 . This is a "BCBS OF MA PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1310984 . This is a "MBHP/VALUE OPTIONS #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 709660 . This is a "TUFTS HLTH PLN PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5035214 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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