Provider Demographics
NPI:1265563506
Name:EDWARD BROOKE CHARTER SCHOOL
Entity type:Organization
Organization Name:EDWARD BROOKE CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-325-7977
Mailing Address - Street 1:190 CUMMINS HWY
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3722
Mailing Address - Country:US
Mailing Address - Phone:617-325-7977
Mailing Address - Fax:617-325-2260
Practice Address - Street 1:190 CUMMINS HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3722
Practice Address - Country:US
Practice Address - Phone:617-325-7977
Practice Address - Fax:617-325-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1955705Medicaid