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General NPI Number Information
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NPI Number | 1174803886
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Entity Type | Organization
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Legal Business Name | DIMOCK COMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 1800 COLUMBUS AVE
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City | ROXBURY
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State | MA
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Zip | 02119-1042
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Country | US
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Telephone | 617-442-8800
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Fax | 617-442-6762
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Provider Business Mailing Address
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Address Line | 1800 COLUMBUS AVE
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City | ROXBURY
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State | MA
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Zip | 02119-1042
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Country | US
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Telephone | 617-442-8800
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Fax | 617-442-6762
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Authorized Official
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Title or Position | EARLY INTERVENTION SPECIALIST
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Name | CHRISTINE ANN LOOMIS
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Credential |
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Telephone | 617-442-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 261QC1500X
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License Number State | MA
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