Healthcare Provider Details

I. General information

NPI: 1295587368
Provider Name (Legal Business Name): LOWELL COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST STE 135
LOWELL MA
01852-2103
US

IV. Provider business mailing address

161 JACKSON ST STE 135
LOWELL MA
01852-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax:
Mailing address:
  • Phone: 978-937-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN WEST LEVINE
Title or Position: CEO
Credential:
Phone: 978-746-7851