Provider Demographics
NPI:1568180339
Name:MERIDIAN HEALTH GROUP LLC
Entity Type:Organization
Organization Name:MERIDIAN HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-988-6900
Mailing Address - Street 1:PO BOX 990001
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-0001
Mailing Address - Country:US
Mailing Address - Phone:617-872-3612
Mailing Address - Fax:
Practice Address - Street 1:30 N GOULD ST STE N
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6317
Practice Address - Country:US
Practice Address - Phone:617-872-3612
Practice Address - Fax:203-538-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty