Basic Information
| Provider Information | |||||||||
| NPI: | 1972021061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES RIVER COMMUNITY HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 WESTERN AVE | ||||||||
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| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021351007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177830500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 43 FOUNDRY AVE | ||||||||
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| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024538313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177830500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2017 | ||||||||
| LastUpdateDate: | 09/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | BROWNE | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6172081511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.