Provider Demographics
NPI:1023567070
Name:PREPARATORY REHABILITATION FOR INDIVIDUAL DEVELOPMENT AND EMPLOYMENT,
Entity Type:Organization
Organization Name:PREPARATORY REHABILITATION FOR INDIVIDUAL DEVELOPMENT AND EMPLOYMENT,
Other - Org Name:PRIDE INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-823-7134
Mailing Address - Street 1:3 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02870
Mailing Address - Country:US
Mailing Address - Phone:508-823-7139
Mailing Address - Fax:508-824-5699
Practice Address - Street 1:3 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02870
Practice Address - Country:US
Practice Address - Phone:508-823-7134
Practice Address - Fax:508-824-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare