Basic Information
Provider Information | |||||||||
NPI: | 1922043876 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FAMILY AND COMMUNITY SOLUTIONS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1125 CENTRE ST | ||||||||
Address2: |   | ||||||||
City: | JAMAICA PLAIN | ||||||||
State: | MA | ||||||||
PostalCode: | 021303445 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6175243116 | ||||||||
FaxNumber: | 8575471138 | ||||||||
Practice Location | |||||||||
Address1: | 77B WARREN ST | ||||||||
Address2: |   | ||||||||
City: | BRIGHTON | ||||||||
State: | MA | ||||||||
PostalCode: | 02135 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177871901 | ||||||||
FaxNumber: | 6172543461 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/17/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GLORIEUX | ||||||||
AuthorizedOfficialFirstName: | MARIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP OF FINANCE | ||||||||
AuthorizedOfficialTelephone: | 6175243116 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ITALIAN HOME FOR CHILDREN INC | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X |   |   | N |   | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |   | 261QM0801X | 4636 | MA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
ID | Type | State | Issuer | Description | M18729 | 01 | MA | BLUE CROSS BLUE SHIELD MA | OTHER | 1301551 | 05 | MA |   | MEDICAID | 701088 | 01 | MA | TUFTS ASSOCIATED HEALTH P | OTHER |