Provider Demographics
NPI:1336306513
Name:CHILD HEALTH FOUNDATION
Entity Type:Organization
Organization Name:CHILD HEALTH FOUNDATION
Other - Org Name:CHARLESTOWN HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND CLINICAL SE
Authorized Official - Prefix:
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 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:SUITE 317
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
Mailing Address - Country:US
Mailing Address - Phone:617-414-5170
Mailing Address - Fax:
Practice Address - Street 1:240 MEDFORD ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1930
Practice Address - Country:US
Practice Address - Phone:617-534-9957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0009888OtherNEIGHBORHOOD HEALTH PLAN