Healthcare Provider Details

I. General information

NPI: 1114969169
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL BOSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE OWL PROGRAM
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE OWL PROGRAM
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-5159
  • Fax:
Mailing address:
  • Phone: 617-355-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number112039
License Number StateMA

VIII. Authorized Official

Name: MS. BRITTANY HARRINGTON
Title or Position: MANAGED CARE ANALYST
Credential:
Phone: 617-355-4956