MEDICARE: THE ASSOCIATION FOR COMMUNITY LIVING

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	251C00000X	Developmentally Disabled Services Day Training Agency	004021	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1906631	OTHER	MA	MASSHEALTH

General Provider Information

NPI Number	:	1841469178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ASSOCIATION FOR COMMUNITY LIVING

Provider Business Mailing Address
First Line	:	1 CARANDO DR STE 2
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-3211
Country	:	US
Telephone Number	:	413-732-0531
Fax Number	:	413-732-1168

Provider Business Practice Location Address
First Line	:	1 CARANDO DR STE 2
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-3211
Country	:	US
Telephone Number	:	413-732-0531
Fax Number	:	413-732-1168

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DONALD J. FLETCHER
Credential	:
Telephone Number	:	413-732-0531

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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