Healthcare Provider Details

I. General information

NPI: 1427365816
Provider Name (Legal Business Name): ELIOT COMMUNITY HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

173 CHELSEA ST
EVERETT MA
02149-4632
US

IV. Provider business mailing address

186 BEDFORD ST
LEXINGTON MA
02420-4436
US

V. Phone/Fax

Practice location:
  • Phone: 781-388-6200
  • Fax: 617-387-9768
Mailing address:
  • Phone: 781-861-0890
  • Fax: 781-861-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN MARKARIAN
Title or Position: PRESIDENT
Credential:
Phone: 781-861-0890