1740209881 NPI number — NORTH SUFFOLK COMMUNITY SERVICES INC.

Table of content: (NPI 1740209881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740209881 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:
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:
1740209881
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:
14 PORTER 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:
02128-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-569-3189
Provider Business Practice Location Address Fax Number:
617-569-7890
Provider Enumeration Date:
07/19/2006

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: 261Q00000X , with the licence number:  4027 , 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: 1301659 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1301926 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1303147 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 708502 . This is a "TUFTS HEALTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1304178 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214325 . This is a "MAGELLAN BEHAVIORAL HLTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 996251-01 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1307398 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A011775 . This is a "MASS. BEHAVIORAL HEALTH PARTNERSHIP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7216 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A012487 . This is a "MASS. BEHAVIORAL HEALTH PARTNERSHIP NODDLES ISLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1002420 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18732 . This is a "BLUE CROSS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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