Organization
COMMONWEALTH OF MASSACHUSETTS-DMH
Active
Other names
SOUTH WEST SUBURBAN SITE
Organization subpart
No
Provider details
NPI number
Authorized official
PETER ANGELOS (SITE DIRECTOR)
(781) 401-9702
Entity
Organization
Contact information
Practice address
5 RANDOLPH ST, DONOVAN BUILDING, 2ND FLOOR, CANTON, MA 02021-2352
(781) 401-9700
Mailing address
5 RANDOLPH ST, DONOVAN BUILDING, 2ND FLOOR, CANTON, MA 02021-2352
(781) 401-9700
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1802356
—
MA
Enumeration date
03/29/2007
Last updated
08/27/2007
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