Provider Demographics
NPI:1083338123
Name:GAVREEL HEALTH CENTER
Entity Type:Organization
Organization Name:GAVREEL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-945-8655
Mailing Address - Street 1:67 S BEDFORD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5108
Mailing Address - Country:US
Mailing Address - Phone:617-945-8655
Mailing Address - Fax:617-608-0674
Practice Address - Street 1:67 S BEDFORD ST STE 400
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5108
Practice Address - Country:US
Practice Address - Phone:617-945-8655
Practice Address - Fax:617-608-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty