=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194840991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER BOSTON CHINESE GOLDEN AGE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 11/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 OAK ST W
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02116-5636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-423-7563
-----------------------------------------------------
Fax | 617-482-8367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 KNEELAND ST SUITE 204
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02111-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-357-0226
-----------------------------------------------------
Fax | 617-426-8946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. RUTH C. MOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-357-0226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------