Healthcare Provider Details

I. General information

NPI: 1255469847
Provider Name (Legal Business Name): CHARLES RIVER ASSOC. FOR RETARDED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 CENTRAL AVE
NEEDHAM MA
02492
US

IV. Provider business mailing address

59 DWIGHT RD
NEEDHAM MA
02492
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-4347
  • Fax: 781-444-5146
Mailing address:
  • Phone: 781-444-4347
  • Fax: 781-444-5146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1311913
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1311913
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MS. HILARY DIETRICH
Title or Position: V.P. OF THERAPEUTIC DAY SERVICES
Credential: BS
Phone: 781-972-1007