Provider Demographics
NPI:1174821532
Name:CAMBRIDGE FAMILY HEALTH NORTH
Entity Type:Organization
Organization Name:CAMBRIDGE FAMILY HEALTH NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGACY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-575-5570
Mailing Address - Street 1:2067 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1340
Mailing Address - Country:US
Mailing Address - Phone:617-575-5570
Mailing Address - Fax:
Practice Address - Street 1:2067 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1340
Practice Address - Country:US
Practice Address - Phone:617-575-5570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN267929261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care