1396866992 NPI number — FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER

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 1396866992 NPI number — FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER
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:
6
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:
1396866992
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:
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:
508-677-3822
Provider Business Mailing Address Fax Number:
508-673-7056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 ROCK ST
Provider Second Line Business Practice Location Address:
2ND FLOOR HOME ASSISTANCE PROGRAM
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-677-3822
Provider Business Practice Location Address Fax Number:
508-676-1640
Provider Enumeration Date:
04/02/2007

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:
508-677-3822

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1900633 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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