MEDICARE: UNLIMITED BEHAVIORAL HEALTH SERVICES OF MASSACHUSETTS, LLC

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	251S00000X	Community/Behavioral Health Agency
2	251S00000X	Community/Behavioral Health Agency		MA

General Provider Information

NPI Number	:	1790189439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLIMITED BEHAVIORAL HEALTH SERVICES OF MASSACHUSETTS, LLC

Provider Business Mailing Address
First Line	:	348 NORTH PEARL STREET
Second Line	:	RM 8
City	:	BROCKTON
State	:	MA
Zip	:	02301-1197
Country	:	US
Telephone Number	:	508-510-5940
Fax Number	:	508-510-6903

Provider Business Practice Location Address
First Line	:	348 NORTH PEARL STREET
Second Line	:	RM
City	:	BROCKTON
State	:	MA
Zip	:	02301-1197
Country	:	US
Telephone Number	:	508-510-5940
Fax Number	:	508-510-6903

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BARBARA A KING
Credential	:	M.ED, CAGS
Telephone Number	:	508-510-5940

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	04/16/2017

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