Provider Demographics
NPI:1275283095
Name:MONTACHUSETT RECOVERY FOUNDATION CORP
Entity Type:Organization
Organization Name:MONTACHUSETT RECOVERY FOUNDATION CORP
Other - Org Name:MONTACHUSETT RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BOYKIN
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LADC II, CARC, CPS
Authorized Official - Phone:978-227-5036
Mailing Address - Street 1:106 CARTER ST STE 40
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-7303
Mailing Address - Country:US
Mailing Address - Phone:978-227-5036
Mailing Address - Fax:
Practice Address - Street 1:106 CARTER ST STE 40
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-7303
Practice Address - Country:US
Practice Address - Phone:978-227-5036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No332900000XSuppliersNon-Pharmacy Dispensing Site
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle