Provider Demographics
NPI:1497091235
Name:MASSACHUSETTS MENTOR
Entity Type:Organization
Organization Name:MASSACHUSETTS MENTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC MENTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-929-0534
Mailing Address - Street 1:259 SAMUEL BARNET BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-1214
Mailing Address - Country:US
Mailing Address - Phone:774-929-0534
Mailing Address - Fax:
Practice Address - Street 1:259 SAMUEL BARNET BLVD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1214
Practice Address - Country:US
Practice Address - Phone:774-929-0534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management