Provider Demographics
NPI:1205473592
Name:MELROSEWAKEFIELD HEALTHCARE, INC.
Entity type:Organization
Organization Name:MELROSEWAKEFIELD HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENHALGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-338-7021
Mailing Address - Street 1:PO BOX 415929
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5929
Mailing Address - Country:US
Mailing Address - Phone:781-338-7021
Mailing Address - Fax:781-338-7096
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110000034FMedicaid