Provider Demographics
NPI:1275564734
Name:CHILD HEALTH FOUNDATION
Entity Type:Organization
Organization Name:CHILD HEALTH FOUNDATION
Other - Org Name:BOSTON UNIVERSITY MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFIORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-414-5170
Mailing Address - Street 1:208 ALGONQUIN TRL
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1993
Mailing Address - Country:US
Mailing Address - Phone:508-309-3347
Mailing Address - Fax:
Practice Address - Street 1:850 HARRISON AVE # ACC5
Practice Address - Street 2:THE ADOLESCENT CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-4086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50604261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3005551Medicaid
MA3005551Medicaid