Provider Demographics
NPI:1093787095
Name:JUSTICE RESOURCE INSTITUTE, INC
Entity Type:Organization
Organization Name:JUSTICE RESOURCE INSTITUTE, INC
Other - Org Name:JRI BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:POND
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-559-4900
Mailing Address - Street 1:160 GOULD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2313
Mailing Address - Country:US
Mailing Address - Phone:781-559-4900
Mailing Address - Fax:781-559-4901
Practice Address - Street 1:380 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3743
Practice Address - Country:US
Practice Address - Phone:978-264-3619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X, 320800000X, 323P00000X
MA4825261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2006548OtherUNITED HEALTH CARE
MA43900B1OtherHARVARD
MA0011091OtherNHP
MAM17118OtherBCBS
MA1309978Medicaid
MA806009OtherTUFTS
MA025263357OtherAETNA
MA806009OtherTUFTS