Healthcare Provider Details

I. General information

NPI: 1851797542
Provider Name (Legal Business Name): COMMONWEALTH CARE ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WINTER ST
BOSTON MA
02108-4720
US

IV. Provider business mailing address

30 WINTER ST
BOSTON MA
02108-4720
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-0600
  • Fax: 617-517-7738
Mailing address:
  • Phone: 617-426-0600
  • Fax: 617-517-7738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY J ROACH
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 617-426-0600