Provider Demographics
NPI:1558587584
Name:RESIDENTIAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:RESIDENTIAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLUS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-884-6333
Mailing Address - Street 1:100 BELLINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3358
Mailing Address - Country:US
Mailing Address - Phone:617-884-6333
Mailing Address - Fax:617-884-3247
Practice Address - Street 1:100 BELLINGHAM ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3358
Practice Address - Country:US
Practice Address - Phone:617-884-6333
Practice Address - Fax:617-884-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1904345Medicaid