1255450631 NPI number — COMMUNITY SERVICES INSTITUTE, INC.

Table of content: (NPI 1255450631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255450631 NPI number — COMMUNITY SERVICES INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY SERVICES INSTITUTE, 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:
INSTITUTE AT NEWTON
Provider Other Organization Name Type Code:
4
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:
1255450631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1695 MAIN ST
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01103-1348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-739-5572
Provider Business Mailing Address Fax Number:
413-739-9972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1695 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01103-1348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-739-5572
Provider Business Practice Location Address Fax Number:
413-739-9972
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BONZEK
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
413-739-5572

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  4436 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 4436 , 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: 1004980 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110027920B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1303856 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 997648 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M18747 . This is a "BCBSMA ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000020081 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110027920A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1307541 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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