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NPI Code Detail

MEDICARE: CREST

MEDICARE: CREST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251C00000XDevelopmentally Disabled Services Day Training Agency11111MA

General Provider Information

NPI Number : 1972964450
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREST
Provider Business Mailing Address
First Line : 9 BRANCH ST
Second Line :
City : METHUEN
State : MA
Zip : 01844-1955
Country : US
Telephone Number : 978-685-3000
Fax Number :
Provider Business Practice Location Address
First Line : 9 BRANCH ST
Second Line :
City : METHUEN
State : MA
Zip : 01844-1955
Country : US
Telephone Number : 978-685-3000
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KIM OLIVEIRA
Credential : CAGS
Telephone Number : 978-685-3000
Provider Enumeration Date : 03/11/2016
Last Update Date : 03/11/2016

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Directions to “CREST ” Practice Location

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