Healthcare Provider Details

I. General information

NPI: 1023175072
Provider Name (Legal Business Name): HABIT OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 EAST COLUMBUS AVE.
SPRINGFIELD MA
01105
US

IV. Provider business mailing address

6183 PASEO DEL NORTE STE 200
CARLSBAD CA
92011-1151
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-3488
  • Fax: 413-731-7381
Mailing address:
  • Phone: 760-710-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1301829
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier110073229
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: LAURA CATES
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 760-710-0819