Provider Demographics
NPI:1164557955
Name:ROXBURY MULTI SERVICE CENTER
Entity Type:Organization
Organization Name:ROXBURY MULTI SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOTSHALK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-427-4470
Mailing Address - Street 1:317 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4302
Mailing Address - Country:US
Mailing Address - Phone:617-427-4470
Mailing Address - Fax:617-442-9419
Practice Address - Street 1:317 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-4302
Practice Address - Country:US
Practice Address - Phone:617-427-4470
Practice Address - Fax:617-442-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309587Medicaid