1639225600 NPI number — CENTER FOR COMPREHENSIVE SERVICES

Table of content: (NPI 1639225600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639225600 NPI number — CENTER FOR COMPREHENSIVE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COMPREHENSIVE SERVICES
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:
1639225600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
639 GRANITE STREET
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
BRAINTREE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-356-6330
Provider Business Mailing Address Fax Number:
781-356-6334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 SUSAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
S. EASTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02375-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-238-3496
Provider Business Practice Location Address Fax Number:
508-238-3578
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. BUSINESS DIRECTOR
Authorized Official Telephone Number:
618-529-3060

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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