Provider Demographics
NPI:1306997473
Name:CENTER FOR COMMUNITY HEALTH, EDUCATION & RESEARCH, INC
Entity type:Organization
Organization Name:CENTER FOR COMMUNITY HEALTH, EDUCATION & RESEARCH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUSTACHE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:617-265-0628
Mailing Address - Street 1:420 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1127
Mailing Address - Country:US
Mailing Address - Phone:617-265-0628
Mailing Address - Fax:617-265-4134
Practice Address - Street 1:745 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1941
Practice Address - Country:US
Practice Address - Phone:617-364-3035
Practice Address - Fax:617-364-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4EDY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1321943Medicaid