Healthcare Provider Details

I. General information

NPI: 1598400442
Provider Name (Legal Business Name): NR MASSACHUSETTS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BEACON ST STE 355
BROOKLINE MA
02446-3202
US

IV. Provider business mailing address

1170 S STATE ST
EPHRATA PA
17522-2601
US

V. Phone/Fax

Practice location:
  • Phone: 717-859-8810
  • Fax: 800-915-6119
Mailing address:
  • Phone: 178-598-8107
  • Fax: 800-915-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ALICIA M SANTOS-PIERCE
Title or Position: CORPORATE OPERATIONS MANAGER
Credential:
Phone: 561-473-9426