Healthcare Provider Details

I. General information

NPI: 1790521508
Provider Name (Legal Business Name): COMMUNITY ACTION AGENCY OF SOMERVILLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-70 UNION SQUARE SUITE 104
SOMERVILLE MA
02143
US

IV. Provider business mailing address

66-70 UNION SQUARE SUITE 104
SOMERVILLE MA
02143
US

V. Phone/Fax

Practice location:
  • Phone: 617-623-7370
  • Fax:
Mailing address:
  • Phone: 617-623-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID GIBBS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 617-623-7370