1134239528 NPI number — CORF INVESTMENT COMPANY INC

Table of content: (NPI 1134239528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134239528 NPI number — CORF INVESTMENT COMPANY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORF INVESTMENT COMPANY 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:
FREEDOM THERAPY CENTER
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:
1134239528
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:
180 WELLS AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02459-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-244-4744
Provider Business Mailing Address Fax Number:
617-244-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 WELLS AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02459-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-244-4744
Provider Business Practice Location Address Fax Number:
617-244-9229
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARBARITA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
617-244-4744

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  451G , 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: AA23525 . This is a "HARVARD PILGRIM PROVIDER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y61392 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3493031 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9763261 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611458 . This is a "TUFTS HEALTH PLAN PROVIDE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3314627 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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