Provider Demographics
NPI:1437325248
Name:CHILD HEALTH FOUNDATION OF BOSTON
Entity Type:Organization
Organization Name:CHILD HEALTH FOUNDATION OF BOSTON
Other - Org Name:NUTRITION AND FITNESS FOR LIFE PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND CLINICAL SE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIFIORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-414-5509
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 1:850 HARRISON AVE
Practice Address - Street 2:ACC5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0006747OtherNEIGHBORHOOD HEALTH PLAN