Healthcare Provider Details

I. General information

NPI: 1609189380
Provider Name (Legal Business Name): STEWARD CARNEY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 DORCHESTER AVE
DORCHESTER CENTER MA
02124-5615
US

IV. Provider business mailing address

2100 DORCHESTER AVE
DORCHESTER CENTER MA
02124-5615
US

V. Phone/Fax

Practice location:
  • Phone: 617-296-4000
  • Fax: 617-562-7241
Mailing address:
  • Phone: 617-296-4000
  • Fax: 617-562-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JAMES RENNA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 617-419-4700