Provider Demographics
NPI:1902954449
Name:HARVARD STREET NEIGHBORHOOD HEALTH CENTER INC
Entity type:Organization
Organization Name:HARVARD STREET NEIGHBORHOOD HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-825-3400
Mailing Address - Street 1:632 BLUE HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121
Mailing Address - Country:US
Mailing Address - Phone:617-822-5520
Mailing Address - Fax:617-282-1450
Practice Address - Street 1:632 BLUE HILL AVENUE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121
Practice Address - Country:US
Practice Address - Phone:617-822-5520
Practice Address - Fax:617-282-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165443336C0002X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2229121OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA110027894BMedicaid
MA1305409Medicaid
221823Medicare PIN
221823Medicare Oscar/Certification