Organization
CHARLES RIVER COMMUNITY HEALTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW LOCKWOOD MULLANEY (CEO)
(617) 783-0500
Entity
Organization
Contact information
Practice address
43 FOUNDRY AVE STE 110, WALTHAM, MA 02453-8313
(781) 693-3800
(781) 693-3817
Mailing address
495 WESTERN AVE, BRIGHTON, MA 02135-1007
(781) 693-3800
(781) 693-3817
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
4157
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110024306T
—
MA
05
—
1320882
—
MA
01
—
2227002110
BCBS
MA
01
—
682536
TUFTS HEALTH PLAN - MED
MA
01
—
686893
TUFTS HEALTH PLAN
MA
01
—
903699
TUFTS HEALTH PLAN - MH
MA
01
—
M12043
BCBS MEDICAL/PODIATRY
MA
01
—
W20419
BCBS - OPTOMETRY
MA
Enumeration date
09/13/2006
Last updated
04/14/2026
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