1871893081 NPI number — INSTITUTE FOR HEALTH AND RECOVERY INC

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 1871893081 NPI number — INSTITUTE FOR HEALTH AND RECOVERY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR HEALTH AND RECOVERY 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:
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:
1871893081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 N BEACON ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02472-2671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-661-3991
Provider Business Mailing Address Fax Number:
617-661-7277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 N BEACON ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02472-2671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-661-3991
Provider Business Practice Location Address Fax Number:
617-661-7277
Provider Enumeration Date:
10/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOLD
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
617-661-3991

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  0845 , 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: 110087398B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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