Provider Demographics
NPI:1831498609
Name:WINTER GARDEN, LLC
Entity Type:Organization
Organization Name:WINTER GARDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKHENIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-787-3333
Mailing Address - Street 1:1284 SOLDIERS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1003
Mailing Address - Country:US
Mailing Address - Phone:617-787-3333
Mailing Address - Fax:
Practice Address - Street 1:1284 SOLDIERS FIELD RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1003
Practice Address - Country:US
Practice Address - Phone:617-787-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-20
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care