Provider Demographics
NPI:1689693343
Name:STANLEY STREET TREATMENT AND RESOURCES, INC.
Entity Type:Organization
Organization Name:STANLEY STREET TREATMENT AND RESOURCES, INC.
Other - Org Name:SSTAR
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-235-3500
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-679-5222
Mailing Address - Fax:508-673-3182
Practice Address - Street 1:386 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-679-5222
Practice Address - Fax:508-673-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0501261QM0801X
261QM2800X
MA0118324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1306685OtherMBHP O/P M/H
MA1306685Medicaid
MAFAL2225000701OtherBCBS I/P
MA295763OtherMAGELLAN
MAA005312/008588OtherVALUE OPTIONS
MA1002950OtherBEACON
MA725921OtherTUFTS
MAFAL2225000710OtherBCBS O/P
MA1306391OtherMBHP I/P
MA000000008464OtherBMC
MASTA2223014140OtherBCBS M/H
MA1002950OtherBEACON