Provider Demographics
NPI:1073263687
Name:MOUNTAINSIDE- MASSACHUSETTS
Entity Type:Organization
Organization Name:MOUNTAINSIDE- MASSACHUSETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-362-5232
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:ASHLEY FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01222-0129
Mailing Address - Country:US
Mailing Address - Phone:860-362-5232
Mailing Address - Fax:877-861-6507
Practice Address - Street 1:187 S CANAAN RD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2544
Practice Address - Country:US
Practice Address - Phone:860-362-5232
Practice Address - Fax:877-861-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility