Provider Demographics
NPI:1205145042
Name:CHILD SERVICES OF ROXBURY
Entity type:Organization
Organization Name:CHILD SERVICES OF ROXBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR FAMILY PARTNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-989-9499
Mailing Address - Street 1:38 BROWNS AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1505
Mailing Address - Country:US
Mailing Address - Phone:617-429-4783
Mailing Address - Fax:
Practice Address - Street 1:38 BROWNS AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-1505
Practice Address - Country:US
Practice Address - Phone:617-429-4783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD SERVICES OF ROXBURY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherFAMILY PARTNER