Provider Demographics
NPI:1578514733
Name:DOTHOUSE HEALTH INC.
Entity Type:Organization
Organization Name:DOTHOUSE HEALTH INC.
Other - Org Name:DOTHOUSE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-740-2277
Mailing Address - Street 1:1353 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2932
Mailing Address - Country:US
Mailing Address - Phone:617-740-2200
Mailing Address - Fax:617-825-4972
Practice Address - Street 1:1353 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2932
Practice Address - Country:US
Practice Address - Phone:617-740-2200
Practice Address - Fax:617-825-4972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOTHOUSE HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-13
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABD8771140OtherFED. CONTROLLED SUBSTANCE
MA1211765Medicaid
MA1211765Medicaid