Provider Demographics
NPI:1720407471
Name:NEIGHBORHOOD HEALTHCARE LLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-424-3774
Mailing Address - Street 1:1266 FURNACE BROOK PKWY STE 403
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4785
Mailing Address - Country:US
Mailing Address - Phone:781-424-3774
Mailing Address - Fax:
Practice Address - Street 1:1266 FURNACE BROOK PKWY STE 403
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4785
Practice Address - Country:US
Practice Address - Phone:781-424-3774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency