Healthcare Provider Details

I. General information

NPI: 1306632062
Provider Name (Legal Business Name): LIFESPAN OF MASSACHUSETTS - TAUNTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N PEARL ST
BROCKTON MA
02301-1794
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-7797
  • Fax:
Mailing address:
  • Phone: 401-444-7797
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EVA GREENWOOD
Title or Position: SVP FINANCE
Credential:
Phone: 401-444-2221