1063655678 NPI number — BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.

Table of content: (NPI 1063655678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063655678 NPI number — BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, 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:
NEW ENGLAND SHELTER FOR HOMELESS VETERANS
Provider Other Organization Name Type Code:
5
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:
1063655678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 ALBANY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02118-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-654-1227
Provider Business Mailing Address Fax Number:
857-654-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-371-1723
Provider Business Practice Location Address Fax Number:
857-654-1473
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEUNG
Authorized Official First Name:
AGNES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
857-654-1200

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  4LQX , 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)





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