Provider Demographics
NPI:1477600831
Name:JEWISH FAMILY & CHILDREN'S SERVICE
Entity Type:Organization
Organization Name:JEWISH FAMILY & CHILDREN'S SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-647-5327
Mailing Address - Street 1:1430 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1623
Mailing Address - Country:US
Mailing Address - Phone:781-647-5327
Mailing Address - Fax:
Practice Address - Street 1:198 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5025
Practice Address - Country:US
Practice Address - Phone:781-551-0405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1803654Medicaid