Provider Demographics
NPI:1114201605
Name:BOSTON PUBLIC HEALTH COMMISSION
Entity Type:Organization
Organization Name:BOSTON PUBLIC HEALTH COMMISSION
Other - Org Name:ASTHMA HOME VISITING & IMMUNIZATION PROG.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BISOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJIKUTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-534-7166
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-5264
Mailing Address - Fax:617-534-7165
Practice Address - Street 1:1010 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2600
Practice Address - Country:US
Practice Address - Phone:617-534-5264
Practice Address - Fax:617-534-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001542401OtherMEDICARE