1932838513 NPI number — STANLEY STREET TREATMENT AND RESOURCES, INC

Table of content: (NPI 1932838513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932838513 NPI number — STANLEY STREET TREATMENT AND RESOURCES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANLEY STREET TREATMENT AND 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:
1932838513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
386 STANLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02720-6009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-675-1054
Provider Business Mailing Address Fax Number:
508-324-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 WEAVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-675-1054
Provider Business Practice Location Address Fax Number:
508-324-7777
Provider Enumeration Date:
06/08/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
85-324-3550

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4379 . This is a "DEPARTMENT OF PUBLIC HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".