MEDICARE: NORTHEAST ADDICTIONS TREATMENT CENTER

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1831547199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST ADDICTIONS TREATMENT CENTER

Provider Business Mailing Address
First Line	:	500 VICTORY RD STE 3
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02171-3132
Country	:	US
Telephone Number	:	617-302-3487
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 WASHINGTON STREET
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-7211
Country	:	US
Telephone Number	:	617-302-3487
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RICHARD MCDONALD
Credential	:
Telephone Number	:	617-302-3487

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	05/13/2021

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