Provider Demographics
NPI:1891053963
Name:DORCHESTER HOUSE MULTI-SERVICE CENTER
Entity Type:Organization
Organization Name:DORCHESTER HOUSE MULTI-SERVICE CENTER
Other - Org Name:BOSTON MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:617-288-3230
Mailing Address - Street 1:22 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2025
Mailing Address - Country:US
Mailing Address - Phone:617-201-3307
Mailing Address - Fax:
Practice Address - Street 1:1353 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2932
Practice Address - Country:US
Practice Address - Phone:617-288-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care