Provider Demographics
NPI:1801087580
Name:USCG
Entity type:Organization
Organization Name:USCG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IDHS
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:AYKROYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-223-3121
Mailing Address - Street 1:427 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1027
Mailing Address - Country:US
Mailing Address - Phone:617-223-3121
Mailing Address - Fax:
Practice Address - Street 1:427 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1027
Practice Address - Country:US
Practice Address - Phone:617-223-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness