1689693343 NPI number — STANLEY STREET TREATMENT AND RESOURCES, INC.

Table of content: (NPI 1689693343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689693343 NPI number — STANLEY STREET TREATMENT AND RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANLEY STREET TREATMENT AND RESOURCES, 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:
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:
1689693343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
386 STANLEY ST
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:
02720-6009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-679-5222
Provider Business Mailing Address Fax Number:
508-673-3182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
386 STANLEY 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:
02720-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-679-5222
Provider Business Practice Location Address Fax Number:
508-673-3182
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
508-235-3500

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  0501 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 0118 , 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: 1306685 . This is a "MBHP O/P M/H" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1306685 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FAL2225000701 . This is a "BCBS I/P" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 295763 . This is a "MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A005312/008588 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1002950 . This is a "BEACON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 725921 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: FAL2225000710 . This is a "BCBS O/P" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1306391 . This is a "MBHP I/P" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000008464 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: STA2223014140 . This is a "BCBS M/H" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com