Healthcare Provider Details

I. General information

NPI: 1568580678
Provider Name (Legal Business Name): TOWN OF NORTHBOROUGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN ST
NORTHBOROUGH MA
01532-1943
US

IV. Provider business mailing address

63 MAIN ST
NORTHBOROUGH MA
01532-1943
US

V. Phone/Fax

Practice location:
  • Phone: 508-486-5115
  • Fax: 508-486-5123
Mailing address:
  • Phone: 508-486-5115
  • Fax: 508-486-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number251300000X
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number251B00000X
License Number StateMA

VIII. Authorized Official

Name: MS. CHERYL LEVESQUE
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 508-486-5115