Provider Demographics
NPI:1578986741
Name:KAHONEY ANDERSON
Entity Type:Organization
Organization Name:KAHONEY ANDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SOCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KAHONEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:339-927-0837
Mailing Address - Street 1:90 PLYMOUTH DR APT 1C
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5474
Mailing Address - Country:US
Mailing Address - Phone:339-927-0387
Mailing Address - Fax:
Practice Address - Street 1:90 PLYMOUTH DRIVE, APT 1C
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:339-927-0837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA313068261Q00000X, 261QD1600X, 261QM0850X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility