Provider Demographics
NPI:1396856704
Name:BOSTON HEALTH CARE FOR WOMEN, INC
Entity Type:Organization
Organization Name:BOSTON HEALTH CARE FOR WOMEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFIK
Authorized Official - Middle Name:ZAKI
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-739-1151
Mailing Address - Street 1:500 BROOKLINE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5417
Mailing Address - Country:US
Mailing Address - Phone:617-739-1151
Mailing Address - Fax:617-278-6905
Practice Address - Street 1:500 BROOKLINE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5417
Practice Address - Country:US
Practice Address - Phone:617-739-1151
Practice Address - Fax:617-278-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9720308Medicaid
MAM13293Medicare ID - Type Unspecified