Manet Community Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Taunton, MA
NPI 1063123271 · NPPES record last updated Mar 3, 2023
Key facts
- NPI
- 1063123271
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MANET COMMUNITY HEALTH CENTER, INC.
- Practice address
- 60 Williams St
Taunton, MA 02780-5411 - Phone
- (617) 404-4102
- NPI assigned
- Dec 8, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- MANET COMMUNITY HEALTH CENTER, INC.
Authorized official
- Name
- Cynthia Sierra
- Title
- Chief Executive Officer
- Phone
- (617) 404-4102
Owners & managing parties with NPI records 1
-
Neda Hovaizi, D.D.S.
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 12
Practitioners 78
-
Tasfia Ahmed, DO, MSC
-
Katy E. Bockstall, M.D.
-
Kelly Burke, NURSE PRACTITIONER
-
Mary P Cahill, CPNP
-
Kiley Callahan, FNP-C
-
Nancy Chung, MSN, FNP-BC
-
Timothy Comeaux, LICSW,LADCI
-
Emily Grace Covert, PA-C
-
Pamela G Gordon, MD
-
Carol Noel Hamilton, FNP
-
Charlette Hines, FNP
-
Katherine Anne Johnson, LICSW
-
Robert Joseph, MD
-
Sarah Kiernan, NP
-
Brian T Kroener, MD, MPH
-
Sarah Krueger, FNP-C
-
Celeste Thi Le, RN, RDN
-
Abigail Benson Lively, MS, RD, CSSD, LD
-
Nicholas Philip Medeiros, PA-C
-
Brittany Ann Nadeau, LICSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Federally qualified health center certification: CCN 221009
- Legal name
- MANET COMMUNITY HEALTH CENTER, INC.
- Doing business as
- MANET COMMUNITY HEALTH CENTER AT TAUNTON PUBLIC SCHOOLS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 13, 2024
- Last certification
- Jun 13, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 5, 1978 in MA
- Enrollment address
- 60 Williams St
# P101
Taunton, MA 27805411
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Cynthia Sierra |
Corporate Officer |
Jan 15, 2016 | 100% |
| Samantha Chen |
Corporate Director |
Jan 15, 2019 | 100% |
| Zachary Eaton |
Corporate Director |
Dec 16, 2014 | 100% |
| Neda Hovaizi |
Corporate Director |
Jan 15, 2019 | 100% |
| Lawrence Flanagan |
Corporate Director |
Feb 21, 2017 | 100% |
| John D Brothers |
Corporate Director |
Dec 5, 2000 | 100% |
| Joseph M Reardon |
Corporate Director |
May 1, 2007 | 100% |
| Robert Griffin |
Corporate Director | Jan 24, 2011 | 100% |
| Jane Kisielius |
Corporate Director |
Dec 17, 2017 | 100% |
| Grace McAuliffe |
Corporate Director |
Dec 17, 2017 | 100% |
| Anita Christie |
Corporate Director |
Dec 17, 2017 | 100% |
| Ivan S Wong |
Corporate Director |
Oct 20, 2009 | 100% |
| Linda a Kelly |
Corporate Director |
May 6, 2006 | 100% |
| Karen Ward |
Corporate Director |
Dec 17, 2017 | 100% |
| Roberto Costa |
Corporate Director |
Dec 17, 2017 | 100% |
| Tara Major |
Corporate Director |
Jan 1, 2024 | 80% |
| Nancy Wyrebek |
Corporate Director |
Dec 17, 2017 | 100% |
| Cathy Liu |
W-2 Managing Employee |
Feb 1, 2024 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240806001656 | MA | Part a Provider - Federally Qualified Health Center (FQHC) | 4486555158 | Practice locations: Taunton, MA |
National Provider Directory
- Tax ID family
- Manet Community Health Center Inc
- Part of
- Manet Community Health Center Inc
Locations
110 W Squantum St
#1
North Quincy, MA 02171
Phone (617) 376-3000
1193 Sea St
Quincy, MA 02169
Phone (617) 471-8683
114 Whitwell St
#2
Quincy, MA 02169
Phone (857) 403-0820
60 Williams St
#P101
Taunton, MA 02780
Phone (857) 358-7260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
60 Williams St
Taunton, MA 02780-5411
Mailing address
110 W Squantum St
Quincy, MA 02171-2122
Phone (617) 404-4102
Other names
- Manet Community Health Center at Taunton Public Schools
Other providers in Taunton, MA
- Jessica A. Maitland
- Sara Makki
- Russell Maling
- Alison Malloch
- Victoria Lyric Mancini
- Manet Community Health Center, Inc.
- Manet Community Health Center, Inc.
- Lynn Mangott
- Kelley Mann
- Magdalene Mann
All providers in Taunton, MA · Federally Qualified Health Center (FQHC) in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.