Provider Demographics
NPI:1679648182
Name:ELIOT COMMUNITY HUMAN SERVICES
Entity Type:Organization
Organization Name:ELIOT COMMUNITY HUMAN SERVICES
Other - Org Name:ELIOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-861-0890
Mailing Address - Street 1:125 HARTWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-3100
Mailing Address - Country:US
Mailing Address - Phone:781-861-0890
Mailing Address - Fax:781-861-0899
Practice Address - Street 1:86 BAKER AVE EXT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-1113
Practice Address - Fax:978-369-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4113261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300911Medicaid
MAM18603OtherBCBS OF MA
MA1005555OtherBEACON HEALTH STRATEGIES
MAM18603OtherBCBS OF MA