Healthcare Provider Details

I. General information

NPI: 1629193776
Provider Name (Legal Business Name): THE NEW ENGLAND CENTER FOR CHILDREN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

IV. Provider business mailing address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-1015
  • Fax: 508-485-3421
Mailing address:
  • Phone: 508-481-1015
  • Fax: 508-485-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number5343
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number02760820
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number02760820
License Number StateMA

VIII. Authorized Official

Name: MR. VINCENT STRULLY JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 508-481-1015