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General NPI Number Information
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NPI Number | 1922460104
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH CARE ALLIANCE
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 529 MAIN ST SUITE 222
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City | CHARLESTOWN
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State | MA
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Zip | 02129-1125
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Country | US
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Telephone | 617-600-3195
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Fax | 617-924-1207
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Provider Business Mailing Address
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Address Line | 529 MAIN ST SUITE 222
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City | CHARLESTOWN
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State | MA
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Zip | 02129-1125
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Country | US
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Telephone | 617-600-3195
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Fax | 617-924-1207
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Authorized Official
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Title or Position | DIRECTOR CLINICAL DOCUMETATION TEAM
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Name | MS. JANET THERESA NORTON
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Credential | RN, CMC, CPC
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Telephone | 617-600-3195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 164402
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License Number State | MA
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