Provider Demographics
NPI:1457653537
Name:SOUTH COVE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH COVE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:LAI WAH
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:617-482-7555
Mailing Address - Street 1:885 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1415
Mailing Address - Country:US
Mailing Address - Phone:617-482-7555
Mailing Address - Fax:617-521-6795
Practice Address - Street 1:885 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1415
Practice Address - Country:US
Practice Address - Phone:617-482-7555
Practice Address - Fax:617-521-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133V00000X261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health