Basic Information
| Provider Information | |||||||||
| NPI: | 1023507761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON HEALTHCARE FOR THE HOMELESS PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2018 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | SIMON | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | RN | ||||||||
| AuthorizedOfficialTelephone: | 5089420067 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2320603 | MA | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.