Provider Demographics
NPI:1568580736
Name:DEPARTMENT OF MENTAL HEALTH
Entity Type:Organization
Organization Name:DEPARTMENT OF MENTAL HEALTH
Other - Org Name:BRIGHTON IRTP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST DIRECTOR OF NON-INST REIMBURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-886-8089
Mailing Address - Street 1:25 STANIFORD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2503
Mailing Address - Country:US
Mailing Address - Phone:617-626-8040
Mailing Address - Fax:617-626-8295
Practice Address - Street 1:BRIGHTON IRTP - EVERETT HOUSE
Practice Address - Street 2:232 CENTRE ST
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2334
Practice Address - Country:US
Practice Address - Phone:617-825-5703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1102958Medicaid