Provider Demographics
NPI:1346668605
Name:STOUGHTON ADULT MEDICAL DAY CARE CENTER, INC.
Entity Type:Organization
Organization Name:STOUGHTON ADULT MEDICAL DAY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BODOIN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, PD
Authorized Official - Phone:508-586-2222
Mailing Address - Street 1:966 PARK ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:508-586-2222
Mailing Address - Fax:508-586-2212
Practice Address - Street 1:966 PARK ST BLDG B
Practice Address - Street 2:SUITE B1
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:508-586-2222
Practice Address - Fax:508-586-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care