MEDICARE: MASSACHUSETTS DETOX CENTERS INC

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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1699442475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSACHUSETTS DETOX CENTERS INC

Provider Business Mailing Address
First Line	:	355 MIDDLESEX AVE UNIT 8
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	362 MIDDLESEX AVE
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2127
Country	:	US
Telephone Number	:	978-737-7937
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID RAY
Credential	:
Telephone Number	:	978-737-7937

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	09/08/2021

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