Provider Demographics
NPI:1750783114
Name:BOSTON CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:BOSTON CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ADMINISTRATIVE ASSOCIATE, PS
Authorized Official - Prefix:
Authorized Official - First Name:CLEO
Authorized Official - Middle Name:
Authorized Official - Last Name:HEREFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-355-2288
Mailing Address - Street 1:124 BYNNER ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-919-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9975282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren