Healthcare Provider Details

I. General information

NPI: 1689159329
Provider Name (Legal Business Name): JEWISH FAMILY & CHILDREN'S SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SHEPARD ST STE 280
BRIGHTON MA
02135-3416
US

IV. Provider business mailing address

1430 MAIN ST
WALTHAM MA
02451-1623
US

V. Phone/Fax

Practice location:
  • Phone: 617-224-4127
  • Fax:
Mailing address:
  • Phone: 781-647-5327
  • Fax: 781-693-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BARRY L. PROBST
Title or Position: MANAGER OF BILLING & REIMBURSEMENT
Credential:
Phone: 781-693-5582