Provider Demographics
NPI:1114924461
Name:TOWN OF STOUGHTON
Entity Type:Organization
Organization Name:TOWN OF STOUGHTON
Other - Org Name:STOUGHTON PUBLIC HEALTH ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:781-344-7011
Mailing Address - Street 1:10 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2364
Mailing Address - Country:US
Mailing Address - Phone:781-344-7011
Mailing Address - Fax:781-344-6238
Practice Address - Street 1:10 PEARL ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2364
Practice Address - Country:US
Practice Address - Phone:781-344-7011
Practice Address - Fax:781-344-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0600431Medicaid
MA227144Medicare Oscar/Certification
MA227144Medicare ID - Type Unspecified