Healthcare Provider Details

I. General information

NPI: 1487994893
Provider Name (Legal Business Name): JAMAICA PLAIN HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 FOREST HILL ST
BOSTON MA
02130-3353
US

IV. Provider business mailing address

26 HARVARD ST
WORCESTER MA
01609-2833
US

V. Phone/Fax

Practice location:
  • Phone: 617-522-1550
  • Fax:
Mailing address:
  • Phone: 508-754-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICK SHEEHAN
Title or Position: MANAGER
Credential:
Phone: 508-754-8877