Provider Demographics
NPI:1750486106
Name:CHARLES RIVER COMMUNITY HEALTH, INC
Entity Type:Organization
Organization Name:CHARLES RIVER COMMUNITY HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-205-1511
Mailing Address - Street 1:495 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1007
Mailing Address - Country:US
Mailing Address - Phone:781-693-3800
Mailing Address - Fax:617-987-8222
Practice Address - Street 1:43 FOUNDRY AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8313
Practice Address - Country:US
Practice Address - Phone:617-783-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4157261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2227002110OtherBCBS
MA1320882Medicaid
MAW20419OtherBCBS - OPTOMETRY
MA903699OtherTUFTS HEALTH PLAN - MH
MAM12043OtherBCBS MEDICAL/PODIATRY
MA686893OtherTUFTS HEALTH PLAN
MA110024306TMedicaid
MA682536OtherTUFTS HEALTH PLAN - MED
MA682536OtherTUFTS HEALTH PLAN - MED