Healthcare Provider Details

I. General information

NPI: 1902954449
Provider Name (Legal Business Name): HARVARD STREET NEIGHBORHOOD HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BLUE HILL AVENUE
DORCHESTER MA
02121
US

IV. Provider business mailing address

632 BLUE HILL AVENUE
DORCHESTER MA
02121
US

V. Phone/Fax

Practice location:
  • Phone: 617-822-5520
  • Fax: 617-282-1450
Mailing address:
  • Phone: 617-822-5520
  • Fax: 617-282-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number16544
License Number StateMA

VIII. Authorized Official

Name: MR. CHARLES A. MURPHY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 617-825-3400