1598400442 NPI number — NR MASSACHUSETTS ASSOCIATES LLC

Table of content: (NPI 1598400442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598400442 NPI number — NR MASSACHUSETTS ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NR MASSACHUSETTS ASSOCIATES LLC
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:
RETREAT BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1598400442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1170 S STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17522-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
178-598-8107
Provider Business Mailing Address Fax Number:
800-915-6119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 BEACON ST STE 355
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02446-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-859-8810
Provider Business Practice Location Address Fax Number:
800-915-6119
Provider Enumeration Date:
05/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SANTOS-PIERCE
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CORPORATE OPERATIONS MANAGER
Authorized Official Telephone Number:
561-473-9426

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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