Provider Demographics
NPI:1518085968
Name:PATRIOT BEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:PATRIOT BEHAVIORAL HEALTH INC.
Other - Org Name:PATRIOT ELDERCARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACCARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-219-1490
Mailing Address - Street 1:1261 FURNACE BROOK PARKWAY
Mailing Address - Street 2:SUITE 22
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-302-2481
Mailing Address - Fax:617-472-6947
Practice Address - Street 1:1261 FURNACE BROOK PARKWAY
Practice Address - Street 2:SUITE 22
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-302-2481
Practice Address - Fax:617-472-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9712411Medicaid
MA9712411Medicaid