Provider Demographics
NPI:1811481625
Name:BOSTON ADULT FOSTER CARE
Entity type:Organization
Organization Name:BOSTON ADULT FOSTER CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUTUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-756-6840
Mailing Address - Street 1:344 TALBOT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3502
Mailing Address - Country:US
Mailing Address - Phone:617-756-6840
Mailing Address - Fax:
Practice Address - Street 1:344 TALBOT AVE STE 201
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3502
Practice Address - Country:US
Practice Address - Phone:617-756-6840
Practice Address - Fax:617-436-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253J00000X
MARN258508163WH0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care AgencyGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANAMedicaid