Healthcare Provider Details

I. General information

NPI: 1942621180
Provider Name (Legal Business Name): CGF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WESLEY ST
CHELSEA MA
02150-1419
US

IV. Provider business mailing address

10 WESLEY ST
CHELSEA MA
02150-1419
US

V. Phone/Fax

Practice location:
  • Phone: 617-370-8081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MCGOVERN
Title or Position: MGR
Credential:
Phone: 617-370-8081