1861724791 NPI number — COMMUNITAS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861724791 NPI number — COMMUNITAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITAS, INC.
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:
AFC
Provider Other Organization Name Type Code:
5
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:
1861724791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 D AUDUBON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-587-2200
Provider Business Mailing Address Fax Number:
781-587-1362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 AUDUBON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-587-2314
Provider Business Practice Location Address Fax Number:
781-587-2315
Provider Enumeration Date:
02/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COTE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CEO & CFO
Authorized Official Telephone Number:
781-587-2220

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  718667 , 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: 1315571 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".