1639537285 NPI number — HABIT OPCO WAREHAM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639537285 NPI number — HABIT OPCO WAREHAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HABIT OPCO WAREHAM
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:
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:
1639537285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1499
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02362-1499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-454-8646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3088 ACRANBERRY HWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E. WAREHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02538-1499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-295-7990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
CLINICIAN
Authorized Official Telephone Number:
774-454-8646

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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