1568473718 NPI number — CATHOLIC CHARITABLE BUREAU OF THE ARCHDIOCESE OF BOSTON, INC.DBA

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 1568473718 NPI number — CATHOLIC CHARITABLE BUREAU OF THE ARCHDIOCESE OF BOSTON, INC.DBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITABLE BUREAU OF THE ARCHDIOCESE OF BOSTON, INC.DBA
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:
LABOURE CENTER ADULT DAY HEALTH
Provider Other Organization Name Type Code:
3
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:
1568473718
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:
275 W BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02127-1943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-268-9670
Provider Business Mailing Address Fax Number:
617-464-2669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 W BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02127-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-268-9670
Provider Business Practice Location Address Fax Number:
617-464-2669
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMBO
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FOR PROGRAMS
Authorized Official Telephone Number:
617-451-7940

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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