Healthcare Provider Details

I. General information

NPI: 1255481107
Provider Name (Legal Business Name): NORTH SUFFOLK COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CONDOR ST
EAST BOSTON MA
02128-1305
US

IV. Provider business mailing address

301 BROADWAY
CHELSEA MA
02150-2807
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax: 617-569-1856
Mailing address:
  • Phone: 617-889-4860
  • Fax: 617-889-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberCERTIFIED BY DPH
License Number StateMA

VIII. Authorized Official

Name: JUDI LEMOINE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-912-7910