Provider Demographics
NPI:1053630863
Name:MERRIMACK VALLEY TRAUMA SERVICES, INC.
Entity Type:Organization
Organization Name:MERRIMACK VALLEY TRAUMA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-400-3040
Mailing Address - Street 1:5900 CORE RD STE 401
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6069
Mailing Address - Country:US
Mailing Address - Phone:843-400-3040
Mailing Address - Fax:843-400-3040
Practice Address - Street 1:5900 CORE RD STE 401
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6069
Practice Address - Country:US
Practice Address - Phone:843-400-3040
Practice Address - Fax:843-400-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9315Medicaid