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General NPI Number Information
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NPI Number | 1396056347
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Entity Type | Organization
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Legal Business Name | HABIT OPCO
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 3086 CRANBERRY HWY
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City | EAST WAREHAM
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State | MA
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Zip | 02538-4801
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Country | US
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Telephone | 508-295-7990
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Fax | 508-295-3781
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Provider Business Mailing Address
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Address Line | 3086 CRANBERRY HWY
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City | EAST WAREHAM
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State | MA
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Zip | 02538-4801
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Country | US
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Telephone | 508-295-7990
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Fax | 508-295-3781
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. FREDERICK RILEY
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Credential | LADAC
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Telephone | 508-295-7990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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