1225014616 NPI number — SHRIVER CLINICAL SERVICES CORPORATION

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 1225014616 NPI number — SHRIVER CLINICAL SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHRIVER CLINICAL SERVICES CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1225014616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 NORTH AVE
Provider Second Line Business Mailing Address:
DOOR 2
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01880-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-279-1260
Provider Business Mailing Address Fax Number:
781-279-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 NORTH AVE
Provider Second Line Business Practice Location Address:
DOOR 14
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01880-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-279-1260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAVALLARI
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
508-384-5567

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com