=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013744200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFESPAN OF MASSACHUSETTS - FALL RIVER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2024
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 795 MIDDLE ST
-----------------------------------------------------
City | FALL RIVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02721-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-674-5600
-----------------------------------------------------
Fax | 617-562-7241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 ELLENFIELD ST STE 101
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-444-6779
-----------------------------------------------------
Fax | 401-444-6912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP, FINANCE
-----------------------------------------------------
Name | EVA GREENWOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-444-7284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------