1245440817 NPI number — MASSACHUSETTS CORRECTIONAL INDUSTRIES

Table of content: (NPI 1245440817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245440817 NPI number — MASSACHUSETTS CORRECTIONAL INDUSTRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSACHUSETTS CORRECTIONAL INDUSTRIES
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:
MASSCOR
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:
1245440817
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:
1 INDUSTRIES DRIVE, BUILDING A
Provider Second Line Business Mailing Address:
PO BOX 188
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02056-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-727-0227
Provider Business Mailing Address Fax Number:
781-762-2971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 COLONY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01440-4238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-632-2000
Provider Business Practice Location Address Fax Number:
888-698-2020
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KARR
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DIRECTOR OF INDUSTRIES
Authorized Official Telephone Number:
617-727-0227

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1537253 . This is a "STATE AGENCY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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