Organization
COMMONWEALTH CARE ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA BLACK NP (REGIONAL CLINICAL DIRECTOR)
(617) 600-3195
Entity
Organization
Contact information
Practice address
529 MAIN ST, CHARLESTOWN, MA 02129-1125
(617) 600-3195
Mailing address
529 MAIN ST, CHARLESTOWN, MA 02129-1125
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
MA
Other
Enumeration date
10/25/2016
Last updated
10/25/2016
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