Healthcare Provider Details

I. General information

NPI: 1093787095
Provider Name (Legal Business Name): JUSTICE RESOURCE INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 MASSACHUSETTS AVE
ACTON MA
01720-3743
US

IV. Provider business mailing address

160 GOULD ST SUITE 300
NEEDHAM MA
02494-2313
US

V. Phone/Fax

Practice location:
  • Phone: 978-264-3619
  • Fax:
Mailing address:
  • Phone: 781-559-4900
  • Fax: 781-559-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4825
License Number StateMA

VIII. Authorized Official

Name: ANDY POND
Title or Position: PRESIDENT
Credential: LICSW
Phone: 781-559-4900