Provider Demographics
NPI:1427101153
Name:ELLIS MEMORIAL & ELDREDGE HOUSE
Entity type:Organization
Organization Name:ELLIS MEMORIAL & ELDREDGE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-695-9307
Mailing Address - Street 1:95 BERKELEY ST
Mailing Address - Street 2:P.O. BOX 352
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6230
Mailing Address - Country:US
Mailing Address - Phone:617-695-9307
Mailing Address - Fax:617-695-9307
Practice Address - Street 1:1 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5215
Practice Address - Country:US
Practice Address - Phone:617-695-9310
Practice Address - Fax:617-695-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care