1366041550 NPI number — MERRIMACK VALLEY ABA SERVICES INC

Table of content: (NPI 1366041550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366041550 NPI number — MERRIMACK VALLEY ABA SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERRIMACK VALLEY ABA 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:
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:
1366041550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
599 CANAL STREET
Provider Second Line Business Mailing Address:
5TH FL EAST SUITE 15-16
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-983-0466
Provider Business Mailing Address Fax Number:
978-983-0467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 CANAL STREET
Provider Second Line Business Practice Location Address:
5TH FL EAST SUITE 15-16
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01840-1245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-980-0466
Provider Business Practice Location Address Fax Number:
978-983-0467
Provider Enumeration Date:
10/20/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ADDISON
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-208-9034

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001465731 . This is a "BUSINESS CERTIFICATE IDENTIFICATION NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 001465731 . This is a "BUSINESS REGISTRATION CERTIFICATE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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