Provider Demographics
NPI:1225074685
Name:TOWN OF DOUGLAS
Entity Type:Organization
Organization Name:TOWN OF DOUGLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PULIC HEALTH NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRAZINA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:KRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,C
Authorized Official - Phone:508-476-4000
Mailing Address - Street 1:29 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2374
Mailing Address - Country:US
Mailing Address - Phone:508-476-4000
Mailing Address - Fax:508-476-0023
Practice Address - Street 1:29 DEPOT ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-2374
Practice Address - Country:US
Practice Address - Phone:508-476-4000
Practice Address - Fax:508-476-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA90361251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY10373Medicare ID - Type UnspecifiedMASS IMMUNIZATION ROSTER