Healthcare Provider Details

I. General information

NPI: 1063570547
Provider Name (Legal Business Name): BRANDON RESIDENTIAL TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 WINTER ST
NATICK MA
01760-1015
US

IV. Provider business mailing address

27 WINTER ST
NATICK MA
01760-1015
US

V. Phone/Fax

Practice location:
  • Phone: 508-655-6400
  • Fax: 508-650-9431
Mailing address:
  • Phone: 508-655-6400
  • Fax: 508-650-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number4903992
License Number StateMA

VIII. Authorized Official

Name: DR. TIMOTHY M. CALLAHAN
Title or Position: EXECUTIVE DIRECTOR
Credential: ED.D.
Phone: 508-655-6400