1184163057 NPI number — STETSON SCHOOL INC., AN AFFILIATE OF SEVEN HILLS FOUNDATION

Table of content: (NPI 1184163057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184163057 NPI number — STETSON SCHOOL INC., AN AFFILIATE OF SEVEN HILLS FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STETSON SCHOOL INC., AN AFFILIATE OF SEVEN HILLS FOUNDATION
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:
1184163057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
455 SOUTH STREET
Provider Business Mailing Address City Name:
BARRE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01005-8909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01005-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-355-4541
Provider Business Practice Location Address Fax Number:
978-355-6335
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
STAITI
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MARKETING AND REFERRALS SPECIALIST
Authorized Official Telephone Number:
978-355-4541

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  9020016 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 322D00000X , with the licence number: 9020017 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: 9020018 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1538403969 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629159462 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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