1003935412 NPI number — COMMONWEALTH OF MASSACHUSETTS-DMH

Table of content: (NPI 1003935412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003935412 NPI number — COMMONWEALTH OF MASSACHUSETTS-DMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH OF MASSACHUSETTS-DMH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAUNTON ATTLEBORO SITE OFFICE CASE MGMT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003935412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 STANIFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-626-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 HODGES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAUNTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02780-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-977-3150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEA
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
SITE DIRECTOR
Authorized Official Telephone Number:
508-977-3150

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  EXEMPT , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1802437 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com