Provider Demographics
NPI:1144479494
Name:LIFE FOCUS CENTER OF CHARLESTOWN, INC
Entity type:Organization
Organization Name:LIFE FOCUS CENTER OF CHARLESTOWN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-242-3423
Mailing Address - Street 1:1 CITY SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3726
Mailing Address - Country:US
Mailing Address - Phone:617-242-3423
Mailing Address - Fax:617-242-5525
Practice Address - Street 1:1 CITY SQ
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3726
Practice Address - Country:US
Practice Address - Phone:617-242-3423
Practice Address - Fax:617-242-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services