1861817504 NPI number — MANET COMMUNITY HEALTH CENTER, INC.

Table of content: (NPI 1861817504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861817504 NPI number — MANET COMMUNITY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANET COMMUNITY HEALTH 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:
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:
1861817504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 W SQUANTUM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02171-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-376-3030
Provider Business Mailing Address Fax Number:
617-690-6903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
TAUNTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-690-6343
Provider Business Practice Location Address Fax Number:
617-690-6903
Provider Enumeration Date:
03/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SIERRA
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
617-404-4101

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  4801 , 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: 1302841 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com