Provider Demographics
NPI:1114054988
Name:EAST BOSTON NEIGHBORHOOD HEALTH CENTER-NEIGHBORHOOD PACE
Entity Type:Organization
Organization Name:EAST BOSTON NEIGHBORHOOD HEALTH CENTER-NEIGHBORHOOD PACE
Other - Org Name:ESP
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. VP/CHIEF OPERATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-568-4714
Mailing Address - Street 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1920
Mailing Address - Country:US
Mailing Address - Phone:671-569-5800
Mailing Address - Fax:617-568-4756
Practice Address - Street 1:10 GOVE ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1920
Practice Address - Country:US
Practice Address - Phone:617-569-5800
Practice Address - Fax:617-568-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1802542251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH2223Medicare ID - Type UnspecifiedPACE