Provider Demographics
NPI:1124516356
Name:ELIOT COMMUNITY HUMAN SERVICES
Entity type:Organization
Organization Name:ELIOT COMMUNITY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPPORT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-734-2028
Mailing Address - Street 1:125 HARTWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-3100
Mailing Address - Country:US
Mailing Address - Phone:781-861-0890
Mailing Address - Fax:
Practice Address - Street 1:1715 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4703
Practice Address - Country:US
Practice Address - Phone:781-861-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIOT COMMUNITY HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-24
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300911Medicaid