1144219551 NPI number — FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER, INC.

Table of content: MANUEL A PAZOS (NPI 1508535311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144219551 NPI number — FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER, 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:
MENTAL HEALTH & SUBSTANCE ABUSE CLINIC
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:
1144219551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02722-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-678-7542
Provider Business Mailing Address Fax Number:
508-676-3699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 ROCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-678-7542
Provider Business Practice Location Address Fax Number:
508-676-3699
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NAGLE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
508-730-1138

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  NONE , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0807X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: 4263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1305441 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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