Provider Demographics
NPI:1417139239
Name:GREATER BOSTON CHINESE GOLDEN AGE CENTER, INC.
Entity Type:Organization
Organization Name:GREATER BOSTON CHINESE GOLDEN AGE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-357-0226
Mailing Address - Street 1:75 KNEELAND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1901
Mailing Address - Country:US
Mailing Address - Phone:617-357-0226
Mailing Address - Fax:617-357-4323
Practice Address - Street 1:75 KNEELAND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1901
Practice Address - Country:US
Practice Address - Phone:617-357-0226
Practice Address - Fax:617-357-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1533193251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1533193Medicaid