| NPI | 1023408309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN M WALTMAN Clinical Supervisor 413-355-6832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MA 745) |
| Additional Taxonomies | 251S00000X (Licence: MA 745) |
| 302F00000X Exclusive Provider Organization (Licence: MA 745) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2015-01-26 |