Basic Information
| Provider Information | |||||||||
| NPI: | 1801107917 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. ANN'S HOME | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100A HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786825276 | ||||||||
| FaxNumber: | 9786884932 | ||||||||
| Practice Location | |||||||||
| Address1: | 100A HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786825276 | ||||||||
| FaxNumber: | 9786884932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2010 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DESHIAES | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENTIAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9786825276 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 1024070 | MA | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.