Organization
CARITAS ST. ELIZABETH'S MEDICAL CENTER-TCU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILES COVERDALE (AUTHORIZED OFFICER)
(617) 562-5482
Entity
Organization
Contact information
Practice address
736 CAMBRIDGE ST, BOSTON, MA 02135-2907
(617) 562-5482
(617) 562-5415
Mailing address
77 WARREN STREET-PROVIDER ENROLLMENT DEPT, BRIGHTON, MA 02135
(617) 562-5482
(617) 562-5415
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
923206
—
MA
Enumeration date
12/06/2006
Last updated
08/22/2020
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