Healthcare Provider Details

I. General information

NPI: 1780524694
Provider Name (Legal Business Name): MANTRA HEALTH ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 SHERWOOD LN
RAYNHAM MA
02767-1623
US

IV. Provider business mailing address

73 SHERWOOD LN
RAYNHAM MA
02767-1623
US

V. Phone/Fax

Practice location:
  • Phone: 617-749-7049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: WOLLKENS LORENA
Title or Position: MANAGER
Credential:
Phone: 617-749-7049