Provider Demographics
NPI:1467737288
Name:BOSTON HAMILTON RECOVERY HOME INC.
Entity Type:Organization
Organization Name:BOSTON HAMILTON RECOVERY HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/CCS
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LICSW, LADAC-1
Authorized Official - Phone:617-288-1584
Mailing Address - Street 1:25 MOUNT IDA RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1709
Mailing Address - Country:US
Mailing Address - Phone:617-288-1584
Mailing Address - Fax:617-288-8881
Practice Address - Street 1:25 MOUNT IDA RD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1709
Practice Address - Country:US
Practice Address - Phone:617-288-1584
Practice Address - Fax:617-288-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230453990730000324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility