Provider Demographics
NPI:1467641126
Name:BOSTON HEALTHCARE VA
Entity Type:Organization
Organization Name:BOSTON HEALTHCARE VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POSTDOCTORAL FELLOW
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:857-364-4122
Mailing Address - Street 1:204 BELLINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4106
Mailing Address - Country:US
Mailing Address - Phone:440-915-6515
Mailing Address - Fax:
Practice Address - Street 1:204 BELLINGHAM AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4106
Practice Address - Country:US
Practice Address - Phone:440-915-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit