Basic Information
| Provider Information | |||||||||
| NPI: | 1528338738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMBRIDGE HEALTH ALLIANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 WINDSOR ST | ||||||||
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| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021393647 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 119 WINDSOR ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021393647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176653600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2012 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | CAPEHART | ||||||||
| AuthorizedOfficialFirstName: | RONNETTE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | RN | ||||||||
| AuthorizedOfficialTelephone: | 6176653600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 22917 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.