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General NPI Number Information
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NPI Number | 1609917053
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Entity Type | Organization
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Legal Business Name | JUSTICE RESOURCE INSTITUTE, INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 365 EAST ST SOUTHGATE BLDG
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City | TEWKSBURY
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State | MA
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Zip | 01876-1950
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Country | US
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Telephone | 978-858-3776
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Fax |
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Provider Business Mailing Address
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Address Line | 160 GOULD ST SUITE 300
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City | NEEDHAM
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State | MA
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Zip | 02494-2313
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Country | US
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Telephone | 781-559-4900
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Fax | 781-559-4901
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDY POND
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Credential | LICSW
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Telephone | 781-599-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 686
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License Number State | MA
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