Healthcare Provider Details

I. General information

NPI: 1689693343
Provider Name (Legal Business Name): STANLEY STREET TREATMENT AND RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 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: 508-679-5222
  • Fax: 508-673-3182
Mailing address:
  • Phone: 508-679-5222
  • Fax: 508-673-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0501
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0118
License Number StateMA

VIII. Authorized Official

Name: SHERRY A ELLIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LICSW
Phone: 508-235-3500