1750487245 NPI number — KENNEDY DONOVAN CENTER, INC

Table of content: (NPI 1750487245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750487245 NPI number — KENNEDY DONOVAN CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEDY DONOVAN CENTER, 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:
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:
1750487245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 COMMERCIAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOXBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02035-2530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-543-2542
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 FOREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-226-6035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODMAN-CONARE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
508-543-2542

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , 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: 0008524 . This is a "EARLY INTERVENTION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: KD0001 . This is a "EARLY INTERVENTION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000021539 . This is a "EARLY INTERVENTION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1802453 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1800647 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1800604 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1800612 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 601795 . This is a "EARLY INTERVENTION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: EI0025 . This is a "EARLY INTERVENTION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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