Provider Demographics
NPI:1861826158
Name:ROXBURY MULTI-SERVICE CENTER
Entity Type:Organization
Organization Name:ROXBURY MULTI-SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY SUPPORT PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:NENKERWON
Authorized Official - Middle Name:
Authorized Official - Last Name:TROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-919-9535
Mailing Address - Street 1:317 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4302
Mailing Address - Country:US
Mailing Address - Phone:617-427-4470
Mailing Address - Fax:
Practice Address - Street 1:317 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-4302
Practice Address - Country:US
Practice Address - Phone:617-427-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS20630711251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health