Provider Demographics
NPI:1427329564
Name:CONVERGENCE SUPPORT INITIATIVE INC.
Entity type:Organization
Organization Name:CONVERGENCE SUPPORT INITIATIVE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUWULYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-467-4180
Mailing Address - Street 1:815 WASHINGTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1690
Mailing Address - Country:US
Mailing Address - Phone:617-467-4180
Mailing Address - Fax:617-467-5361
Practice Address - Street 1:2802 STEARNS HILL RD
Practice Address - Street 2:STEARNS HILL ROAD
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-3356
Practice Address - Country:US
Practice Address - Phone:617-467-4180
Practice Address - Fax:617-467-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAT9FQ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health