Provider Demographics
NPI:1013416387
Name:ENGRACE BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ENGRACE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBINOSUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-203-2009
Mailing Address - Street 1:950 N MAIN ST # 202
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3064
Mailing Address - Country:US
Mailing Address - Phone:617-203-2009
Mailing Address - Fax:
Practice Address - Street 1:950 N MAIN ST # 202
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3064
Practice Address - Country:US
Practice Address - Phone:617-203-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty