Healthcare Provider Details

I. General information

NPI: 1538530167
Provider Name (Legal Business Name): COMMONWEALTH COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NORTHAMPTON STREET
BOSTON MA
02118
US

IV. Provider business mailing address

30 NORTHAMPTON STREET
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-433-9601
  • Fax: 617-445-6538
Mailing address:
  • Phone: 617-433-9601
  • Fax: 617-445-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA HANTZ
Title or Position: ADMIN DIRECTOR
Credential:
Phone: 617-304-5905