# PINE STREET INN, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639337280
- **Authorized official:** MR. TERRENCE B GAGNE (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (617) 892-9116

## Contact information

- **Practice address:** 28 ROCKWELL ST, DORCHESTER CENTER, MA 02124-4438
- **Practice address phone:** (617) 892-8802
- **Practice address fax:** (617) 825-9020
- **Mailing address:** 444 HARRISON AVE, BOSTON, MA 02118-2404
- **Mailing address phone:** (617) 482-4944
- **Mailing address fax:** (617) 451-1890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/30/2008
- **Last updated:** 05/30/2008