Provider Demographics
NPI:1982906277
Name:ELIOT COMMUNITY HUMAN SERVICE
Entity type:Organization
Organization Name:ELIOT COMMUNITY HUMAN SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAR COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LING
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-395-0457
Mailing Address - Street 1:730 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5924
Mailing Address - Country:US
Mailing Address - Phone:781-395-0457
Mailing Address - Fax:
Practice Address - Street 1:730 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5924
Practice Address - Country:US
Practice Address - Phone:781-395-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management