1093787095 NPI number — JUSTICE RESOURCE INSTITUTE, INC

Table of content: (NPI 1093787095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093787095 NPI number — JUSTICE RESOURCE INSTITUTE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUSTICE RESOURCE INSTITUTE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093787095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 GOULD ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02494-2313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-559-4900
Provider Business Mailing Address Fax Number:
781-559-4901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ACTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01720-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-264-3619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POND
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-559-4900

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 4825 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2006548 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 43900B1 . This is a "HARVARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011091 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17118 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1309978 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806009 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 025263357 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 108728900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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