Healthcare Provider Details

I. General information

NPI: 1932266533
Provider Name (Legal Business Name): ROXBURY COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 WARREN ST
ROXBURY MA
02119-1833
US

IV. Provider business mailing address

435 WARREN ST
ROXBURY MA
02119-1833
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-7400
  • Fax:
Mailing address:
  • Phone: 617-442-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANITA L. CRAWFORD
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 617-442-7400