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General NPI Number Information
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NPI Number | 1760719553
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Entity Type | Organization
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Legal Business Name | PELHAM ACADEMY
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 13 PELHAM RD
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City | LEXINGTON
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State | MA
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Zip | 02421-5707
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Country | US
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Telephone | 781-274-6800
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Fax | 781-274-0900
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Provider Business Mailing Address
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Address Line | 13 PELHAM ROAD
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City | LEXINGTON
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State | MA
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Zip | 02421
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Country | US
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Telephone | 781-274-6800
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Fax | 781-274-0900
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Authorized Official
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Title or Position | YOUTH MENTOR
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Name | MRS. ABIGAIL ORTIZ
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Credential |
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Telephone | 781-274-6800
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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 |
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License Number State |
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