Provider Demographics
NPI:1376328237
Name:CDPH SERVICES LLC
Entity Type:Organization
Organization Name:CDPH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDLER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFFILY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:978-335-5164
Mailing Address - Street 1:6 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4256
Mailing Address - Country:US
Mailing Address - Phone:978-335-5164
Mailing Address - Fax:
Practice Address - Street 1:40 SHATTUCK RD STE 220
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2456
Practice Address - Country:US
Practice Address - Phone:978-494-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)