Healthcare Provider Details

I. General information

NPI: 1760719553
Provider Name (Legal Business Name): PELHAM ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PELHAM RD
LEXINGTON MA
02421-5707
US

IV. Provider business mailing address

13 PELHAM ROAD
LEXINGTON MA
02421
US

V. Phone/Fax

Practice location:
  • Phone: 781-274-6800
  • Fax: 781-274-0900
Mailing address:
  • Phone: 781-274-6800
  • Fax: 781-274-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ABIGAIL ORTIZ
Title or Position: YOUTH MENTOR
Credential:
Phone: 781-274-6800