=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275071730
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIS COLLEGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2017
-----------------------------------------------------
Last Update Date | 02/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 PRESCOTT DR
-----------------------------------------------------
City | N CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01863-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-846-9446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 61 PRESCOTT DR
-----------------------------------------------------
City | N CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01863-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RNC
-----------------------------------------------------
Name | JENNIFER MARIE ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-846-9446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number | 215612
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------