Provider Demographics
NPI:1457397986
Name:WHITTIER STREET HEALTH CENTER COMMITTEE INC
Entity Type:Organization
Organization Name:WHITTIER STREET HEALTH CENTER COMMITTEE INC
Other - Org Name:WHITTIER STREET HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO / VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-989-3230
Mailing Address - Street 1:1290 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3432
Mailing Address - Country:US
Mailing Address - Phone:617-427-1000
Mailing Address - Fax:617-858-2674
Practice Address - Street 1:1290 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-3432
Practice Address - Country:US
Practice Address - Phone:617-427-1000
Practice Address - Fax:617-858-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4144261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1399578Medicaid
MA221824Medicare Oscar/Certification
MA1399578Medicaid