Healthcare Provider Details

I. General information

NPI: 1144635913
Provider Name (Legal Business Name): BOSTON PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ELDERWOOD DR
STOUGHTON MA
02072-4983
US

IV. Provider business mailing address

20 ELDERWOOD DR
STOUGHTON MA
02072-4983
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-8072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number117202
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number117202
License Number StateMA

VIII. Authorized Official

Name: MRS. JANNETTE BRUNSON
Title or Position: SCHOOL NURSE
Credential:
Phone: 617-635-8072