Organization
COMMONWEALTH OF MASSACHUSETTS-DMH
Active
Other names
Southeast Area Office Rehab Option
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD DAILEY (AREA OPERATIONS MANAGER)
(508) 897-2000
Entity
Organization
Contact information
Practice address
165 QUINCY ST, BROCKTON, MA 02302-2988
(508) 897-2000
Mailing address
25 STANIFORD ST, BOSTON, MA 02114-2503
(617) 626-8000
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
EXEMPT
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1802674
—
MA
Enumeration date
03/28/2007
Last updated
08/22/2020
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