Provider Demographics
NPI:1932271632
Name:ELIOT COMMUNITY HUMAN SERVICES
Entity Type:Organization
Organization Name:ELIOT COMMUNITY HUMAN SERVICES
Other - Org Name:TRI-CITY MENTAL HEALTH AND RETARDATION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-861-0890
Mailing Address - Street 1:125 HARTWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-3100
Mailing Address - Country:US
Mailing Address - Phone:781-861-0890
Mailing Address - Fax:781-861-0899
Practice Address - Street 1:125 HARTWELL AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421
Practice Address - Country:US
Practice Address - Phone:781-861-0890
Practice Address - Fax:781-861-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4321261QM0801X
MA0730261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0009253OtherNEIGHBORHOOD HEALTH PLAN
MA1304852Medicaid
MA260000472OtherTRAVERLERS INS. RR-MEDICA
MA702286OtherTUFTS ASSOC. HEALTH
MAEI0M35OtherBAYSTATE HEALTH EI
MA1003010OtherMH NHP BEACON HEALTH
MA1307908Medicaid
MA84645OtherUS HEALTH CARE
MAEI0032OtherEI BCBSMA
MA1300873Medicaid
MA1310275Medicaid
MA1800809Medicaid
MAFS2030290OtherADMINISTAR DEFENSE SERVIC
MA286694OtherMERIT BEHAVIORAL CARE
MATRI2223002641OtherBCBSMA
MA601959OtherHARVARD PILGRIM HEALTH
MAEI0M35OtherBAYSTATE HEALTH EI
MAY15014Medicare UPIN
MA1800809Medicaid