Basic Information
| Provider Information | |||||||||
| NPI: | 1629193776 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE NEW ENGLAND CENTER FOR CHILDREN, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 TURNPIKE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017722108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084811015 | ||||||||
| FaxNumber: | 5084853421 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 TURNPIKE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017722108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084811015 | ||||||||
| FaxNumber: | 5084853421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | STRULLY | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5084811015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 5343 | MA | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 252Y00000X | 02760820 | MA | N | Agencies | Early Intervention Provider Agency | 251S00000X | 02760820 | MA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | P82 | 01 | MA | NTEE | OTHER |