Healthcare Provider Details

I. General information

NPI: 1023232998
Provider Name (Legal Business Name): LA ALIANZA HISPANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 DUDLEY ST
ROXBURY MA
02119-3366
US

IV. Provider business mailing address

409 DUDLEY ST
ROXBURY MA
02119-3366
US

V. Phone/Fax

Practice location:
  • Phone: 617-427-7175
  • Fax: 617-442-2259
Mailing address:
  • Phone: 617-427-7175
  • Fax: 617-442-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROSA MARIA COLON
Title or Position: CONTRACT MANAGER
Credential:
Phone: 617-427-7175