1821159880 NPI number — FAMILY AND COMMUNITY RESOURCES, INC.

Table of content: (NPI 1821159880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821159880 NPI number — FAMILY AND COMMUNITY RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY AND COMMUNITY RESOURCES, 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:
1821159880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 NEWTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301-5115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-583-6498
Provider Business Mailing Address Fax Number:
508-583-3775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 NEWTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-5115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-583-6498
Provider Business Practice Location Address Fax Number:
508-583-3775
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
CLAUDETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
508-583-6498

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  4695 DPH , 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: 1302981 . This is a "MBHP ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 95074701 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1302981 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 725287 . This is a "TUFTS ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18532 . This is a "BCBS ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003790 . This is a "BEACON HEALTH ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com