Provider Demographics
NPI:1326193269
Name:DIMOCK COMMUNITY SERVICES CORPORATION
Entity Type:Organization
Organization Name:DIMOCK COMMUNITY SERVICES CORPORATION
Other - Org Name:DIMOCK COMMUNITY SERVICES CORP.
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO/SVP
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GERONDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-442-8800
Mailing Address - Street 1:55 DIMOCK STREET
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119
Mailing Address - Country:US
Mailing Address - Phone:617-442-8800
Mailing Address - Fax:617-442-4088
Practice Address - Street 1:41 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1208
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:617-442-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA221862OtherMEDICARE UGS
MA1301241Medicaid
MA221862Medicare Oscar/Certification
MA1301241Medicaid
MA221862Medicare UPIN