Provider Demographics
NPI:1114117983
Name:NORTHWOOD BEHAVIORAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:NORTHWOOD BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHREIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-615-4191
Mailing Address - Street 1:512 W MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6405
Mailing Address - Country:US
Mailing Address - Phone:508-845-0100
Mailing Address - Fax:508-845-0400
Practice Address - Street 1:512 W MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6405
Practice Address - Country:US
Practice Address - Phone:508-845-0100
Practice Address - Fax:508-845-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)