Healthcare Provider Details

I. General information

NPI: 1992778781
Provider Name (Legal Business Name): WALDEN BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/27/2021
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CAREMATRIX DR
DEDHAM MA
02026-6149
US

IV. Provider business mailing address

51 SAWYER RD STE 510
WALTHAM MA
02453-3448
US

V. Phone/Fax

Practice location:
  • Phone: 781-647-6700
  • Fax: 781-647-6755
Mailing address:
  • Phone: 781-647-6705
  • Fax: 781-647-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number679
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. STUART KOMAN
Title or Position: PRESIDENT CEO
Credential: PHD
Phone: 781-647-2929