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General NPI Number Information
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NPI Number | 1205791142
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Entity Type | Organization
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Legal Business Name | THE COMMONWEALTH OF MASSACHUSETTS
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 165 MARSTON STREET
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City | LAWRENCE
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State | MA
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Zip | 01841
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Country | US
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Telephone | 978-750-1900
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Fax | 978-750-1998
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Provider Business Mailing Address
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Address Line | 20 MANNING AVE
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City | MIDDLETON
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State | MA
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Zip | 01949-9998
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Country | US
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Telephone | 978-750-1900
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Fax | 978-750-1998
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Authorized Official
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Title or Position | ASSISTANT SUPERINTENDENT
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Name | MR. JASON WILLIAM FARO
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Credential |
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Telephone | 978-750-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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