Provider Demographics
NPI:1487664884
Name:CHARLES RIVER COMMUNITY HEALTH, INC
Entity Type:Organization
Organization Name:CHARLES RIVER COMMUNITY HEALTH, INC
Other - Org Name:JOSEPH M. SMITH COMMUNITY HEALTH CENTER, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-208-1511
Mailing Address - Street 1:495 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1007
Mailing Address - Country:US
Mailing Address - Phone:617-783-0500
Mailing Address - Fax:617-987-8222
Practice Address - Street 1:495 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1007
Practice Address - Country:US
Practice Address - Phone:617-783-0500
Practice Address - Fax:617-987-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4157261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA682536OtherTUFTS HEALTH PLAN
MA686893OtherTUFTS HEALTH PLAN
MAM12043OtherBCBS MEDICAL/PODIATRY
MAW20419OtherBCBS OPTOMETRY
MA2227002110OtherBCBS
MA1301446Medicaid
MA903699OtherTUFTS HEALTH PLAN
MA682536OtherTUFTS HEALTH PLAN
MAM12043Medicare ID - Type UnspecifiedMEDICARE B