| NPI | 1962645572 |
|---|---|
| Other Name | PINE STREET INN AT SHATTUCK |
| Entity Type | Organization |
| Authorized Contact | AGNES W LEUNG Chief Financial Officer 857-654-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MA 4LQX) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2018-05-23 |