Organization
USCG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MICHAEL AYKROYD (IDHS)
(617) 223-3121
Entity
Organization
Contact information
Practice address
427 COMMERCIAL ST, BOSTON, MA 02109-1027
(617) 223-3121
Mailing address
427 COMMERCIAL ST, BOSTON, MA 02109-1027
(617) 223-3121
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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