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General NPI Number Information
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NPI Number | 1376574103
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Entity Type | Organization
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Legal Business Name | MANET COMMUNITY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 1193 SEA ST
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City | QUINCY
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State | MA
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Zip | 02169-3544
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Country | US
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Telephone | 617-471-8683
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Fax | 617-773-1625
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Provider Business Mailing Address
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Address Line | 110 W SQUANTUM ST
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City | NORTH QUINCY
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State | MA
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Zip | 02171-2122
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Country | US
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Telephone | 617-376-3030
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Fax | 617-774-1906
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CYNTHIA SIERRA
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Credential |
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Telephone | 617-404-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 4801
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License Number State | MA
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