Healthcare Provider Details

I. General information

NPI: 1063438133
Provider Name (Legal Business Name): STANLEY STREET TREATMENT AND RESOURCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STANLEY ST
FALL RIVER MA
02720-6009
US

IV. Provider business mailing address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-1054
  • Fax: 508-324-7777
Mailing address:
  • Phone: 508-675-1054
  • Fax: 508-324-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number4379
License Number StateMA

VIII. Authorized Official

Name: MS. BETH CANTAFIO
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 508-675-1054