Provider Demographics
NPI:1184030488
Name:CHRISTA L. MAXANT, INC.
Entity Type:Organization
Organization Name:CHRISTA L. MAXANT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-796-5054
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-0454
Mailing Address - Country:US
Mailing Address - Phone:978-796-5054
Mailing Address - Fax:
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-796-5054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health