1306989702 NPI number — GREATER LAWRENCE FAMILY HEALTH CENTER, INC.

Table of content: (NPI 1306989702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306989702 NPI number — GREATER LAWRENCE FAMILY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER LAWRENCE FAMILY HEALTH 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:
6
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:
1306989702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GRIFFIN BROOK DR STE 101
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
METHUEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01844-1865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-689-6635
Provider Business Mailing Address Fax Number:
978-722-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 HAVERHILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01841-2884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-688-1567
Provider Business Practice Location Address Fax Number:
978-688-6314
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SILVA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
978-725-7400

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: DS3364 , 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: 2039514 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110020863A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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