Provider Demographics
NPI:1689318503
Name:FENWAY COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:FENWAY COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING AND COLLECTIONS
Authorized Official - Prefix:
Authorized Official - First Name:MOIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-927-6279
Mailing Address - Street 1:PO BOX 847492
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7492
Mailing Address - Country:US
Mailing Address - Phone:617-927-6050
Mailing Address - Fax:617-927-5410
Practice Address - Street 1:359 GREEN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3334
Practice Address - Country:US
Practice Address - Phone:617-927-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FENWAY COMMUNITY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303546Medicaid