Healthcare Provider Details

I. General information

NPI: 1336306182
Provider Name (Legal Business Name): ECUMENICAL SOCIAL ACTION COMMITTEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 WASHINGTON ST SUITE 5
JAMAICA PLAIN MA
02130-2691
US

IV. Provider business mailing address

3313 WASHINGTON ST SUITE 5
JAMAICA PLAIN MA
02130-2691
US

V. Phone/Fax

Practice location:
  • Phone: 617-524-2555
  • Fax: 617-524-2430
Mailing address:
  • Phone: 617-524-2555
  • Fax: 617-524-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM A. MINKLE
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential:
Phone: 617-524-2555