Provider Demographics
NPI:1326275926
Name:GREATER LAWRENCE FAMILY HEALTH CENTER INC
Entity Type:Organization
Organization Name:GREATER LAWRENCE FAMILY HEALTH CENTER INC
Other - Org Name:GREATER LAWRENCE FAMILY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-725-7400
Mailing Address - Street 1:1 GRIFFIN BROOK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1865
Mailing Address - Country:US
Mailing Address - Phone:978-689-6635
Mailing Address - Fax:978-688-6314
Practice Address - Street 1:700 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-4396
Practice Address - Country:US
Practice Address - Phone:978-691-6248
Practice Address - Fax:978-683-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS896753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020863HMedicaid
2121325OtherPK
MA110020863HMedicaid