| Organization Name: | CODMAN SQUARE HEALTH CENTER, INC |
| NPI Number: | 1396808309 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDRA COTTERELL (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 637 Washington St Dorchester Center |
| State: | MA US |
| Postal Code: | 021243510 |
| Phone Number: | 6178259660 |
| Fax Number: | 6172887898 |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 09/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |