1255481107 NPI number — NORTH SUFFOLK COMMUNITY SERVICES INC.

Table of content: (NPI 1255481107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255481107 NPI number — NORTH SUFFOLK COMMUNITY SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SUFFOLK COMMUNITY SERVICES 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:
NORTH SUFFOLK MENTAL HEALTH ASSOCIATION, INC.
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:
1255481107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELSEA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02150-2807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-889-4860
Provider Business Mailing Address Fax Number:
617-889-4635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 CONDOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02128-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-569-6560
Provider Business Practice Location Address Fax Number:
617-569-1856
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEMOINE
Authorized Official First Name:
JUDI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
617-912-7910

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X , with the licence number:  CERTIFIED BY DPH , 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: 612900 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: EI0002 . This is a "BLUE CROSS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 42317215002 . This is a "TRICARE-CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006844 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 821870 . This is a "AETNA-US HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 99625101 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3836587 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 708502 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000005443 . This is a "BMC HEALTHNET-EI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1800515 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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