Healthcare Provider Details

I. General information

NPI: 1811473267
Provider Name (Legal Business Name): DEVENS TREATMENT & RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PATTON RD
DEVENS MA
01434-4401
US

IV. Provider business mailing address

85 PATTON RD
DEVENS MA
01434-4401
US

V. Phone/Fax

Practice location:
  • Phone: 978-615-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL P KRUPA
Title or Position: CEO
Credential:
Phone: 978-615-5200