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General NPI Number Information
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NPI Number | 1922101724
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Entity Type | Organization
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Legal Business Name | THE COMMONWEALTH OF MASSACHUSETTS
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 60 HODGES AVE
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City | TAUNTON
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State | MA
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Zip | 02780-3034
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Country | US
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Telephone | 508-977-3110
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4007
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City | TAUNTON
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State | MA
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Zip | 02780-0997
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. JONATHAN CARVALHO
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Credential |
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Telephone | 507-977-3121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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