Provider Demographics
NPI:1154594067
Name:PASSPORT HEALTH
Entity type:Organization
Organization Name:PASSPORT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-418-3675
Mailing Address - Street 1:600 W CUMMINGS PARK STE 1300
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6376
Mailing Address - Country:US
Mailing Address - Phone:617-418-3675
Mailing Address - Fax:781-939-5755
Practice Address - Street 1:600 W CUMMINGS PARK STE 1300
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6376
Practice Address - Country:US
Practice Address - Phone:617-418-3675
Practice Address - Fax:781-939-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244342172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty