Organization
INTERIM HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT RALPH MADARUSO LADC1 (CLINICAL DIRECTOR)
(617) 265-2636
Entity
Organization
Contact information
Practice address
62 WALDECK ST, DORCHESTER, MA 02124-1329
(617) 265-2636
Mailing address
62 WALDECK ST, DORCHESTER, MA 02124-1329
(617) 265-2636
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1697
MA
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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