1942337290 NPI number — TOWARD INDEPENDENT LIVING & LEARNING, INC.

Table of content: DR. KIMBERLY JONES MARBURY PHARMD (NPI 1588944193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942337290 NPI number — TOWARD INDEPENDENT LIVING & LEARNING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWARD INDEPENDENT LIVING & LEARNING, 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:
1942337290
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:
20 EASTBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-2075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-302-4604
Provider Business Mailing Address Fax Number:
781-234-1104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 BOSTON RD
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
NORTH BILLERICA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01862-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-302-4604
Provider Business Practice Location Address Fax Number:
781-234-1104
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOCK
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT - OPERATIONS
Authorized Official Telephone Number:
781-302-4604

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1311743 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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