1134695083 NPI number — CENTRAL BOSTON ELDER SERVICES, INC.

Table of content: MIGUEL ANGEL DE JESUS (NPI 1316621352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134695083 NPI number — CENTRAL BOSTON ELDER SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL BOSTON ELDER SERVICES, 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:
1134695083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2315 WASHINGTON STREET
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:
02119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-277-7416
Provider Business Mailing Address Fax Number:
617-731-2005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 WASHINGTON STREET
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:
02119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-277-7416
Provider Business Practice Location Address Fax Number:
617-731-2005
Provider Enumeration Date:
10/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HARDAWAY
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
617-277-7416

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110024276B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com