Provider Demographics
NPI:1134314131
Name:JUSTICE RESOURCE INSTITUTE, INC
Entity Type:Organization
Organization Name:JUSTICE RESOURCE INSTITUTE, INC
Other - Org Name:
Other - Org Type:
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 1:160 WALDEN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3622
Practice Address - Country:US
Practice Address - Phone:978-369-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA490392322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18650OtherBCBS