| NPI | 1629095674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LUISI Executive Director 617-643-8080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: MA 4143) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MA 4143) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MA 4143) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: MA 4143) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-08-22 |