Provider Demographics
NPI:1245743483
Name:WEBSTER''S COACH, LLC
Entity Type:Organization
Organization Name:WEBSTER''S COACH, LLC
Other - Org Name:SHEILA R. WELLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:II
Authorized Official - Credentials:MHA
Authorized Official - Phone:774-200-1786
Mailing Address - Street 1:33 ELECTRIC AVE STE B03
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7954
Mailing Address - Country:US
Mailing Address - Phone:978-627-3929
Mailing Address - Fax:
Practice Address - Street 1:33 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7954
Practice Address - Country:US
Practice Address - Phone:978-627-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW DAWN INTEGRATED BEHAVIORAL HEALTH CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1477517407Medicaid