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General NPI Number Information
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NPI Number | 1558894261
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH COMMUNITY RECOVERY DIVISION INC
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 79 THOMPSON ST
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City | SPRINGFIELD
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State | MA
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Zip | 01109-3921
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Country | US
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Telephone | 888-680-4667
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Fax | 888-726-8386
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Provider Business Mailing Address
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Address Line | 79 THOMPSON ST
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City | SPRINGFIELD
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State | MA
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Zip | 01109-3921
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Country | US
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Telephone | 888-680-4667
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Fax | 888-726-8386
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL JONES
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Credential |
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Telephone | 888-680-4667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | S49769293
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License Number State | MA
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