Provider Demographics
NPI:1629537444
Name:FAIRWINDS-NANTUCKET'S COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:FAIRWINDS-NANTUCKET'S COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-471-9975
Mailing Address - Street 1:20 VESPER LN
Mailing Address - Street 2:L-1 GOUIN VILLAGE
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4394
Mailing Address - Country:US
Mailing Address - Phone:508-228-2689
Mailing Address - Fax:508-228-3613
Practice Address - Street 1:20 VESPER LN
Practice Address - Street 2:L-1 GOUIN VILLAGE
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4394
Practice Address - Country:US
Practice Address - Phone:508-228-2689
Practice Address - Fax:508-228-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty