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NPI Code Detail

MEDICARE: VIDADE CORPORATION

MEDICARE: VIDADE CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1305R00000XPreferred Provider Organization
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1558503342
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIDADE CORPORATION
Provider Business Mailing Address
First Line : 1960 WASHINGTON ST
Second Line : 1960
City : BOSTON
State : MA
Zip : 02118-3219
Country : US
Telephone Number : 617-516-0280
Fax Number :
Provider Business Practice Location Address
First Line : 1960 WASHINGTON ST
Second Line : 1960
City : BOSTON
State : MA
Zip : 02118-3219
Country : US
Telephone Number : 617-516-0280
Fax Number :
Authorized Official
Title or Position : MHA
Name : MS. VIDADE M RATEAU
Credential :
Telephone Number : 857-753-9760
Provider Enumeration Date : 03/25/2009
Last Update Date : 03/25/2009

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Directions to “VIDADE CORPORATION ” Practice Location

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