Provider Demographics
NPI:1154455020
Name:SOMERVILLE CAMBRIDGE ELDER SERVICES
Entity Type:Organization
Organization Name:SOMERVILLE CAMBRIDGE ELDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-628-2601
Mailing Address - Street 1:61 MEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3429
Mailing Address - Country:US
Mailing Address - Phone:617-628-2601
Mailing Address - Fax:617-628-1085
Practice Address - Street 1:61 MEDFORD ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3429
Practice Address - Country:US
Practice Address - Phone:617-628-2601
Practice Address - Fax:617-628-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1901206Medicaid