Provider Demographics
NPI:1205167459
Name:ACTION FOR BOSTON COMMUNITY DEVELOPMENT
Entity type:Organization
Organization Name:ACTION FOR BOSTON COMMUNITY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-348-6260
Mailing Address - Street 1:178 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1006
Mailing Address - Country:US
Mailing Address - Phone:617-348-6256
Mailing Address - Fax:617-357-6810
Practice Address - Street 1:105 CHAUNCY ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1726
Practice Address - Country:US
Practice Address - Phone:617-348-6256
Practice Address - Fax:617-357-6810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110029585Medicaid