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Intermediate Care Facility, Mental Illness

Lawrence, Massachusetts

Provider NPI: 1417084088

Organization Information:

Practice Location:
Tel: 978-682-5593  Fax: --

Business Mailing Address:
Tel: --  Fax: --


PrimaryCodeCategory/DescriptionStateLicense Number
Y310500000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mental Illness

Other Provider Identifiers:

EMP ID NO.72010830MA01
STATE ID NO.023528MA01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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