Provider Demographics
NPI:1477742039
Name:ELIOT COMMUNITY HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:ELIOT COMMUNITY HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FEE FOR SERVICE CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC
Authorized Official - Phone:781-581-4400
Mailing Address - Street 1:95 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1524
Mailing Address - Country:US
Mailing Address - Phone:781-581-4400
Mailing Address - Fax:
Practice Address - Street 1:95 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1524
Practice Address - Country:US
Practice Address - Phone:781-581-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029 AD261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder