Provider Demographics
NPI:1609998392
Name:BRIDGEWATER-RAYNHAM REGIONAL
Entity Type:Organization
Organization Name:BRIDGEWATER-RAYNHAM REGIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GAULTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-697-6902
Mailing Address - Street 1:166 MOUNT PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1352
Mailing Address - Country:US
Mailing Address - Phone:508-697-6902
Mailing Address - Fax:
Practice Address - Street 1:166 MOUNT PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1352
Practice Address - Country:US
Practice Address - Phone:508-697-6902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215B00000X251B00000X
MA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1952935Medicaid