Healthcare Provider Details

I. General information

NPI: 1114027539
Provider Name (Legal Business Name): MANET COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W SQUANTUM ST
NORTH QUINCY MA
02171-2122
US

IV. Provider business mailing address

110 W SQUANTUM ST
NORTH QUINCY MA
02171-2122
US

V. Phone/Fax

Practice location:
  • Phone: 617-376-3030
  • Fax: 617-774-1906
Mailing address:
  • Phone: 617-376-3030
  • Fax: 617-774-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number4801
License Number StateMA

VIII. Authorized Official

Name: CYNTHIA SIERRA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-404-4101