1760433700 NPI number — THE FAMILY CENTER, INC

Table of content: (NPI 1760433700)

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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