Provider Demographics
NPI:1114402807
Name:DORCHESTER HOUSE MULTI SERVICE CENTER
Entity Type:Organization
Organization Name:DORCHESTER HOUSE MULTI SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUGER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:617-740-2303
Mailing Address - Street 1:1353 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2932
Mailing Address - Country:US
Mailing Address - Phone:617-740-2303
Mailing Address - Fax:617-740-2563
Practice Address - Street 1:1353 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2932
Practice Address - Country:US
Practice Address - Phone:617-740-2303
Practice Address - Fax:617-740-2563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORCHESTER HOUSE MULTI SERVICE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center