Healthcare Provider Details

I. General information

NPI: 1427101153
Provider Name (Legal Business Name): ELLIS MEMORIAL & ELDREDGE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHANDLER ST
BOSTON MA
02116-5215
US

IV. Provider business mailing address

95 BERKELEY ST P.O. BOX 352
BOSTON MA
02116-6230
US

V. Phone/Fax

Practice location:
  • Phone: 617-695-9310
  • Fax: 617-695-9309
Mailing address:
  • Phone: 617-695-9307
  • Fax: 617-695-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEO DELANEY
Title or Position: CEO
Credential:
Phone: 617-695-9307