Healthcare Provider Details

I. General information

NPI: 1699110270
Provider Name (Legal Business Name): CHILDREN SERVICES OF ROXBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 DUDLEY ST
ROXBURY MA
02119-2769
US

IV. Provider business mailing address

585 SHAWMUT AVE
BOSTON MA
02118-1777
US

V. Phone/Fax

Practice location:
  • Phone: 617-445-6655
  • Fax:
Mailing address:
  • Phone: 617-445-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMA

VIII. Authorized Official

Name: PAMELA OGLETREE
Title or Position: CEO
Credential:
Phone: 617-445-6655