Organization
FENWAY COMMUNITY HEALTH CENTER, INC
Active
Other names
Fenway Health
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF LIEBERMAN (VP FINANCE & ADMINISTRATION)
(617) 927-6173
Entity
Organization
Contact information
Practice address
1340 BOYLSTON ST, BOSTON, MA 02215-4302
(617) 927-4880
Mailing address
1340 BOYLSTON ST, BOSTON, MA 02215-4302
(617) 927-4880
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
4519
MA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
4519
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1303546
—
MA
Enumeration date
10/06/2005
Last updated
07/07/2011
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