Basic Information
| Provider Information | |||||||||
| NPI: | 1760695878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER LAWRENCE FAMILY HEALTH CENTER INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 GRIFFIN BROOK PARK DR | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018441865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786860090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 ESSEX STREET | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786892400 | ||||||||
| FaxNumber: | 9786830663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERNARD | ||||||||
| AuthorizedOfficialFirstName: | KARIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROJECT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9786896683 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 4943 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 1303775 | 05 | MA | MEDICAID |