Provider Demographics
NPI:1063549962
Name:ITALIAN HOME FOR CHILDREN INC
Entity type:Organization
Organization Name:ITALIAN HOME FOR CHILDREN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLORIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-524-3116
Mailing Address - Street 1:1125 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3445
Mailing Address - Country:US
Mailing Address - Phone:617-524-3116
Mailing Address - Fax:857-547-1138
Practice Address - Street 1:1125 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3445
Practice Address - Country:US
Practice Address - Phone:617-524-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 322D00000X
MA4636261QM0801X
MA1475185320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1899929Medicaid
MAF47287OtherNETWORK HEALTH
MA1019890OtherBEACON HEALTH OPTIONS (NOT STRATEGIES)
MA110032625OtherMASSHEALTH
MA1899929Medicaid