Healthcare Provider Details

I. General information

NPI: 1396890240
Provider Name (Legal Business Name): DIMOCK COMMUNITY SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FORT AVE
ROXBURY MA
02119-1433
US

IV. Provider business mailing address

55 DIMOCK ST
ROXBURY MA
02119-1029
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-6778
  • Fax:
Mailing address:
  • Phone: 617-442-8800
  • Fax: 617-445-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateMA

VIII. Authorized Official

Name: MR. DAVID WHITHAM
Title or Position: DIRECTOR IT & AR
Credential:
Phone: 617-442-8800