1861663445 NPI number — SOUTHERN WORCESTER COUNTY ARC INC

Table of content: (NPI 1861663445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861663445 NPI number — SOUTHERN WORCESTER COUNTY ARC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN WORCESTER COUNTY ARC 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:
1861663445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01550-0066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-764-4085
Provider Business Mailing Address Fax Number:
508-765-0255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FOSTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01550-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-764-4085
Provider Business Practice Location Address Fax Number:
508-765-0255
Provider Enumeration Date:
03/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
508-764-4085

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1317563 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1300148 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1317571 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1901419 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1304330 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com