Provider Demographics
NPI:1225358245
Name:ELIOT COMMUNITY SERVICE AGENCY
Entity Type:Organization
Organization Name:ELIOT COMMUNITY SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-304-6320
Mailing Address - Street 1:10 CABOT ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CABOT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5177
Practice Address - Country:US
Practice Address - Phone:617-304-6320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization