Basic Information
| Provider Information | |||||||||
| NPI: | 1497823579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARITAS CARNEY HOSPITAL-PSYCHIATRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 MIDDLE ST | ||||||||
| Address2: | SAINT ANNE'S HOSPITAL | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027211733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082355401 | ||||||||
| FaxNumber: | 5082355330 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 DORCHESTER AVENUE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172964000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | GUYON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MGR | ||||||||
| AuthorizedOfficialTelephone: | 6177893450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 1010352 | 05 | MA | MEDICAID |