Healthcare Provider Details

I. General information

NPI: 1104819572
Provider Name (Legal Business Name): TOWN OF BILLERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GOOD ST
BILLERICA MA
01821-1807
US

IV. Provider business mailing address

19 NORFOLK AVE STE B
SOUTH EASTON MA
02375-1911
US

V. Phone/Fax

Practice location:
  • Phone: 978-671-0900
  • Fax:
Mailing address:
  • Phone: 888-771-6115
  • Fax: 508-297-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3055
License Number StateMA

VIII. Authorized Official

Name: DANIEL ROSA
Title or Position: CHIEF
Credential:
Phone: 978-671-0900