Healthcare Provider Details

I. General information

NPI: 1417181769
Provider Name (Legal Business Name): SOUTHEASTERN MA EDUCATIONAL COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RUSSELLS MILLS ROAD
DARTMOUTH MA
02748
US

IV. Provider business mailing address

25 RUSSELLS MILLS ROAD
DARTMOUTH MA
02748
US

V. Phone/Fax

Practice location:
  • Phone: 508-858-5127
  • Fax: 508-858-5129
Mailing address:
  • Phone: 508-858-5127
  • Fax: 508-858-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: MRS. CATHERINE S COOPER
Title or Position: EXECUTIVE DIRECTOR
Credential: J.D.
Phone: 508-998-5599