NPIMap

Organization Active NPI

Manet Community Health Center, Inc.

Doing business as Manet Community Health Center, Inc. at Snug Harbor

  • Federally Qualified Health Center (FQHC)
  • Quincy, MA
National Provider Identifier
1891731956
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4801 Issued in MA
Legal business name
MANET COMMUNITY HEALTH CENTER, INC.
Doing business as
Manet Community Health Center, Inc. at Snug Harbor
Practice address
9 Bicknell St
Quincy, MA 02169-6003
Phone
(617) 471-4715
Fax
(617) 472-4977
NPI assigned
Jun 20, 2006
Last updated
Dec 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Antonia G. McGuire, R.N.,M.P.H.
Title
Chief Executive Officer
Phone
(617) 376-3030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4801 MA Primary

Addresses

Primary practice location

9 Bicknell St
Quincy, MA 02169-6003

Mailing address

110 W Squantum St
North Quincy, MA 02171-2122
Phone (617) 376-3030

Other identifiers 1

IdentifierTypeStateIssuer
1304879MedicaidMA

Other names 1

  • Manet Community Health Center, Inc. at Snug Harbor Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050311000097 MA Part A Provider - Federally Qualified Health Center (FQHC) 4486555158 Practice locations: Quincy, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891731956. Details of each certification follow.

Federally qualified health center certification: CCN 221865

Legal name
MANET COMMUNITY HEALTH CENTER, INC.
Doing business as
MANET COMMUNITY HEALTH CENTER AT SNUG HARBOR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2005
Last certification
Mar 16, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1978 in MA
Enrollment address
9 Bicknell Street
Quincy, MA 21696003

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Manet Community Health Center Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cynthia Sierra Individual Corporate OfficerChief Executive Officer Jan 1, 2016 100%
Samantha Chen Individual Corporate DirectorBoard Member Jan 15, 2009 75%
Zachary Eaton Individual Corporate DirectorBoard Member Jan 15, 2009 75%
Neda Hovaizi Individual Corporate DirectorBoard Member Jan 15, 2019 75%
Lawrence Flanagan Individual Corporate DirectorBoard Member Feb 21, 2017 75%
Stephen Keches Individual Corporate DirectorBoard Member Jan 16, 2018 75%
John D Brothers Individual Corporate DirectorBoard Member Dec 5, 2000
Joseph M Reardon Individual Corporate Director Oct 14, 2010
Robert Griffin Individual Corporate DirectorBoard Member Jan 24, 2011
Lavinia M Roosa Individual Operational/Managerial ControlDirector of Revenue Mar 5, 2001 50%
Jane Kisielius Individual Corporate DirectorBoard Member Dec 17, 2017 75%
Grace McAuliffe Individual Corporate DirectorBoard Member Dec 17, 2017 75%
Anita Christie Individual Corporate DirectorBoard Member Mar 17, 2023 75%
Ivan S Wong Individual Corporate Director Oct 14, 2010
Linda a Kelly Individual Corporate Director Oct 14, 2010
Karen Ward Individual Corporate DirectorBoard Member Mar 17, 2023 75%
Roberto Costa Individual Corporate Director Mar 17, 2023 75%
Nancy Wyrebek Individual Corporate Director Mar 17, 2023 75%
Anne Bisson Individual Corporate DirectorBoard Member Nov 15, 2016 75%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1891731956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W SQUANTUM ST",
            "city": "NORTH QUINCY",
            "state": "MA",
            "postal_code": "021712122",
            "telephone_number": "617-376-3030",
            "fax_number": "617-774-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 BICKNELL ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021696003",
            "telephone_number": "617-471-4715",
            "fax_number": "617-472-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANET COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "MCGUIRE",
        "authorized_official_first_name": "ANTONIA",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-376-3030",
        "authorized_official_credential": "R.N.,M.P.H."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1304879",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manet Community Health Center, Inc. at Snug Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Quincy, MA

Sources for this page

Verify at the official NPI Registry.