Provider Demographics
NPI:1760108047
Name:GREATER LAWRENCE FAMILY HEALTH CENTER INC
Entity Type:Organization
Organization Name:GREATER LAWRENCE FAMILY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-724-7400
Mailing Address - Street 1:1 GRIFFIN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1865
Mailing Address - Country:US
Mailing Address - Phone:978-725-7400
Mailing Address - Fax:
Practice Address - Street 1:25 MARSTON ST APT 101
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2356
Practice Address - Country:US
Practice Address - Phone:978-722-2870
Practice Address - Fax:978-722-3077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER LAWRENCE FAMILY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)