| NPI | 1821159880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDETTE KELLY Billing Director 508-583-6498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MA 4695 DPH) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-02-10 |