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General NPI Number Information
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NPI Number | 1609099910
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH OF MASSACHUSETTS
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 49 NURSERY LANE
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City | FITCHBURG
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State | MA
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Zip | 01420
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Country | US
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Telephone | 978-342-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 40 BROAD STREET 4TH FLOOR
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City | BOSTON
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State | MA
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Zip | 02109
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Country | US
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Telephone | 617-727-5608
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Fax | 617-624-7577
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Authorized Official
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Title or Position | DEPUTY COMMISSIONER OF ADMINSTRATI
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Name | DYLAN LATTIMORE
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Credential |
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Telephone | 857-408-0675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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