Provider Demographics
NPI:1689031106
Name:BOSTON HEALTHCARE FOR THE HOMELESS
Entity Type:Organization
Organization Name:BOSTON HEALTHCARE FOR THE HOMELESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:857-654-1002
Mailing Address - Street 1:1220 ADAMS ST
Mailing Address - Street 2:G17
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5752
Mailing Address - Country:US
Mailing Address - Phone:917-334-2916
Mailing Address - Fax:
Practice Address - Street 1:1220 ADAMS ST
Practice Address - Street 2:G17
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5752
Practice Address - Country:US
Practice Address - Phone:917-334-2916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220519251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health