1700913514 NPI number — BOSTON CENTER FOR INDEPENDENT LIVING, 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 1700913514 NPI number — BOSTON CENTER FOR INDEPENDENT LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON CENTER FOR INDEPENDENT LIVING, 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:
1700913514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 TEMPLE PL
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02111-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-338-6665
Provider Business Mailing Address Fax Number:
617-338-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 TEMPLE PL
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02111-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-338-6665
Provider Business Practice Location Address Fax Number:
617-338-6661
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENNING
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
16173386665

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , 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: 5800005 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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