Provider Demographics
NPI:1316568330
Name:WALDEN BEHAVIORAL CARE LLC
Entity Type:Organization
Organization Name:WALDEN BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:ROSSIGNOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-647-2922
Mailing Address - Street 1:51 SAWYER RD STE 510
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3448
Mailing Address - Country:US
Mailing Address - Phone:781-647-2922
Mailing Address - Fax:781-647-6755
Practice Address - Street 1:10 CAREMATRIX DR
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6149
Practice Address - Country:US
Practice Address - Phone:781-647-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy