Healthcare Provider Details

I. General information

NPI: 1891096160
Provider Name (Legal Business Name): LAMOUR COMMUNITY HEALTH INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 DIAUTO DR
RANDOLPH MA
02368-4510
US

IV. Provider business mailing address

42 DIAUTO DR
RANDOLPH MA
02368-4510
US

V. Phone/Fax

Practice location:
  • Phone: 781-885-7252
  • Fax: 781-885-7256
Mailing address:
  • Phone: 781-885-7252
  • Fax: 781-885-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4K60
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICE LAMOUR
Title or Position: PRESIDENT
Credential: MSW,LICSW,CAGS
Phone: 781-885-7252