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Residential Treatment Facilities Substance Abuse Rehabilitation Facility

Provider NPI: 1336689389

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
23 PAGE ST  DORCHESTER, MA 02121-4013 US
Tel: 857-261-2934  Fax: --

Business Mailing Address:
23 PAGE ST 2 DORCHESTER, MA 02121-4013 US
Tel: 857-261-2934  Fax: --

NPI Information:
NPI: 1336689389
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y324500000XResidential Treatment Facilities
Substance Abuse Rehabilitation Facility

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 324500000X





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