Provider Demographics
NPI:1639537285
Name:HABIT OPCO WAREHAM
Entity Type:Organization
Organization Name:HABIT OPCO WAREHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS MED
Authorized Official - Phone:774-454-8646
Mailing Address - Street 1:PO BOX 1499
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02362-1499
Mailing Address - Country:US
Mailing Address - Phone:774-454-8646
Mailing Address - Fax:
Practice Address - Street 1:3088 ACRANBERRY HWY.
Practice Address - Street 2:
Practice Address - City:E. WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-1499
Practice Address - Country:US
Practice Address - Phone:508-295-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization