MEDICARE: EDUCATION COLLABORATIVE FOR GREATER BOSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1306162904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCATION COLLABORATIVE FOR GREATER BOSTON

Provider Business Mailing Address
First Line	:	281 WINTER ST
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02451-8740
Country	:	US
Telephone Number	:	617-738-5600
Fax Number	:	781-290-4923

Provider Business Practice Location Address
First Line	:	131 EMERALD ST
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1902
Country	:	US
Telephone Number	:	508-384-5551
Fax Number	:	508-384-5612

Authorized Official
Title or Position	:	DIRECTOR OF CONTRACT MANAGEMENT
Name	:	HENDRIK KOPPERL
Credential	:
Telephone Number	:	617-738-5600

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	04/08/2010

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