Provider Demographics
NPI:1225179567
Name:JUSTICE RESOURCE INSTITUTE
Entity Type:Organization
Organization Name:JUSTICE RESOURCE INSTITUTE
Other - Org Name:DDS DAY AND MOBILE HAB
Other - Org Type:Doing Business As
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 1:180 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2829
Practice Address - Country:US
Practice Address - Phone:508-872-0669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301233Medicaid