1306446059 NPI number — THE KEY PROGRAM, INCORPORATED.

Table of content: (NPI 1306446059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306446059 NPI number — THE KEY PROGRAM, INCORPORATED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE KEY PROGRAM, INCORPORATED.
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:
1306446059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 OLD CONNECTICUT PATH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01701-4548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-877-3690
Provider Business Mailing Address Fax Number:
508-366-9524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01109-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-781-6485
Provider Business Practice Location Address Fax Number:
413-788-6925
Provider Enumeration Date:
10/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LYTTLE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-877-3690

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1306839 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M17759 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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