Provider Demographics
NPI:1871130153
Name:EAST BOSTON FAMILY WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:EAST BOSTON FAMILY WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-633-5221
Mailing Address - Street 1:274 DEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-2045
Mailing Address - Country:US
Mailing Address - Phone:617-633-5221
Mailing Address - Fax:
Practice Address - Street 1:999 SARATOGA ST STE 3
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1238
Practice Address - Country:US
Practice Address - Phone:617-633-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy