Provider Demographics
NPI:1063846384
Name:CAMBRIDGE HEALTH ALLIANCE
Entity Type:Organization
Organization Name:CAMBRIDGE HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCYNE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PUOPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:CARN
Authorized Official - Phone:617-591-6058
Mailing Address - Street 1:26 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2827
Mailing Address - Country:US
Mailing Address - Phone:617-591-6058
Mailing Address - Fax:617-591-6054
Practice Address - Street 1:26 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2827
Practice Address - Country:US
Practice Address - Phone:617-591-6058
Practice Address - Fax:617-591-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA414871283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital