Organization
PINE STREET INN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRENCE B GAGNE (CHIEF FINANCIAL OFFICER)
(617) 892-9116
Entity
Organization
Contact information
Practice address
28 ROCKWELL ST, DORCHESTER CENTER, MA 02124-4438
(617) 892-8802
(617) 825-9020
Mailing address
444 HARRISON AVE, BOSTON, MA 02118-2404
(617) 482-4944
(617) 451-1890
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1803492
—
MA
Enumeration date
05/30/2008
Last updated
05/30/2008
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