Provider Demographics
NPI:1346728748
Name:T MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:T MASSACHUSETTS, LLC
Other - Org Name:HOSPITAL FOR BEHAVIORAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-243-5565
Mailing Address - Street 1:100 CENTURY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606
Mailing Address - Country:US
Mailing Address - Phone:774-366-7000
Mailing Address - Fax:774-701-0950
Practice Address - Street 1:100 CENTURY DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:774-366-7000
Practice Address - Fax:774-701-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110150798Medicaid