Provider Demographics
NPI:1255469847
Name:CHARLES RIVER ASSOC. FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:CHARLES RIVER ASSOC. FOR RETARDED CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF THERAPEUTIC DAY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:781-972-1007
Mailing Address - Street 1:59 DWIGHT RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492
Mailing Address - Country:US
Mailing Address - Phone:781-444-4347
Mailing Address - Fax:781-444-5146
Practice Address - Street 1:989 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492
Practice Address - Country:US
Practice Address - Phone:781-444-4347
Practice Address - Fax:781-444-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1311913251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1311913Medicaid