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NPI Code Detail

MEDICARE: ECUMENICAL SOCIAL ACTION COMMITTEE, INC.

MEDICARE: ECUMENICAL SOCIAL ACTION COMMITTEE, INC.
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1336306182
Entity Type Code : Organization
Provider Name (Legal Business Name) : ECUMENICAL SOCIAL ACTION COMMITTEE, INC.
Provider Business Mailing Address
First Line : 3313 WASHINGTON ST
Second Line : SUITE 5
City : JAMAICA PLAIN
State : MA
Zip : 02130-2691
Country : US
Telephone Number : 617-524-2555
Fax Number : 617-524-2430
Provider Business Practice Location Address
First Line : 3313 WASHINGTON ST
Second Line : SUITE 5
City : JAMAICA PLAIN
State : MA
Zip : 02130-2691
Country : US
Telephone Number : 617-524-2555
Fax Number : 617-524-2430
Authorized Official
Title or Position : INTERIM EXECUTIVE DIRECTOR
Name : MR. WILLIAM A. MINKLE
Credential :
Telephone Number : 617-524-2555
Provider Enumeration Date : 05/20/2008
Last Update Date : 05/20/2008

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