Provider Demographics
NPI:1689958761
Name:MEN'S STABILIZATION
Entity Type:Organization
Organization Name:MEN'S STABILIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, EDM
Authorized Official - Phone:617-983-0351
Mailing Address - Street 1:170 MORTON ST
Mailing Address - Street 2:MEN'S STABILIZATION
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3735
Mailing Address - Country:US
Mailing Address - Phone:617-983-0351
Mailing Address - Fax:617-522-0217
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:MEN'S STABILIZATON
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-983-0351
Practice Address - Fax:617-522-0217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEFOUND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health