Provider Demographics
NPI:1891230058
Name:SOMERVILLE-CAMBRIDGE ELDER SERVICES, INC
Entity Type:Organization
Organization Name:SOMERVILLE-CAMBRIDGE ELDER SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-628-2601
Mailing Address - Street 1:61 MEDFORD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3421
Mailing Address - Country:US
Mailing Address - Phone:617-628-2601
Mailing Address - Fax:
Practice Address - Street 1:61 MEDFORD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3421
Practice Address - Country:US
Practice Address - Phone:617-628-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1926133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty