Healthcare Provider Details

I. General information

NPI: 1184751364
Provider Name (Legal Business Name): ST. ANN'S HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100A HAVERHILL ST
METHUEN MA
01844-4241
US

IV. Provider business mailing address

100A HAVERHILL ST
METHUEN MA
01844-4241
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-5276
  • Fax: 978-794-8233
Mailing address:
  • Phone: 978-682-5276
  • Fax: 978-794-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4KCZ
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number4KCZ
License Number StateMA

VIII. Authorized Official

Name: MRS. SHARON CUTTER
Title or Position: CFO
Credential:
Phone: 978-682-5276