1962548024 NPI number — MEETING STREET MASSACHUSETTS

Table of content: (NPI 1962548024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962548024 NPI number — MEETING STREET MASSACHUSETTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEETING STREET MASSACHUSETTS
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:
MEETING STREET PEDIATRIC REHABILITATION SERVICES
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:
1962548024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 POSA PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-996-3391
Provider Business Mailing Address Fax Number:
508-996-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 POSA PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-3391
Provider Business Practice Location Address Fax Number:
508-996-3397
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ISHERWOOD
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
DIRECTOR OF OUTPATIENT REHAB
Authorized Official Telephone Number:
401-533-9250

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000025520 . This is a "BOSTON MEDICAL REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1399993 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 682632 . This is a "UNITED HEALTH CARE REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006553 . This is a "NEIGHBORHOOD HEALTH REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000025521 . This is a "BOSTON MEDICAL REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 601047 . This is a "HARVARD PILGRIM REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 695483 . This is a "TUFTS REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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