Healthcare Provider Details

I. General information

NPI: 1770817272
Provider Name (Legal Business Name): HIGH POINT TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 STATE RD
PLYMOUTH MA
02360-5133
US

IV. Provider business mailing address

1233 STATE RD
PLYMOUTH MA
02360-5133
US

V. Phone/Fax

Practice location:
  • Phone: 508-224-7701
  • Fax:
Mailing address:
  • Phone: 508-224-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number214777
License Number StateMA

VIII. Authorized Official

Name: DANIEL S MUMBAUER
Title or Position: PRESIDENT / CEO
Credential:
Phone: 508-997-0475