Basic Information
| Provider Information | |||||||||
| NPI: | 1255450631 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY SERVICES INSTITUTE, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | INSTITUTE AT NEWTON | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1695 MAIN ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011031348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137395572 | ||||||||
| FaxNumber: | 4137399972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1695 MAIN ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011031348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137395572 | ||||||||
| FaxNumber: | 4137399972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/12/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SACCO | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 4137395572 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 4436 | MA | N | Agencies | Community/Behavioral Health | 261QM0801X | 4436 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 110027920A | 05 | MA | MEDICAID | 1004980 | 05 | MA | MEDICAID | 1303856 | 05 | MA | MEDICAID | 1307541 | 05 | MA | MEDICAID | 000000020081 | 05 | MA | MEDICAID | 110027920B | 05 | MA | MEDICAID | 997648 | 05 | MA | MEDICAID | M18747 | 01 | MA | BCBSMA ID | OTHER |