Provider Demographics
NPI:1639219314
Name:GOSNOLD, INC.
Entity Type:Organization
Organization Name:GOSNOLD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:V
Authorized Official - Last Name:TAMASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-540-6550
Mailing Address - Street 1:200 TER HEUN DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2525
Mailing Address - Country:US
Mailing Address - Phone:508-540-6550
Mailing Address - Fax:508-540-7480
Practice Address - Street 1:200 TER HEUN DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2525
Practice Address - Country:US
Practice Address - Phone:508-540-6550
Practice Address - Fax:508-540-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4600261QM0801X
MA0532261QR0405X
MA50.101.01320800000X
MA0103324500000X
MA0246324500000X
MA0234324500000X
MA0403324500000X
MA0002324500000X
MA14752453245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1310518Medicaid
MA1306723Medicaid
MAY62140Medicare ID - Type UnspecifiedLICPSY
MA1310518Medicaid
MAY10357Medicare ID - Type UnspecifiedMD, RN