Provider Demographics
NPI:1700394962
Name:MIDDLESEX HUMAN SERVICE AGENCY, INC.
Entity Type:Organization
Organization Name:MIDDLESEX HUMAN SERVICE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC I, NCAC II, SAP
Authorized Official - Phone:781-894-6110
Mailing Address - Street 1:50 PROSPECT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8509
Mailing Address - Country:US
Mailing Address - Phone:781-894-6110
Mailing Address - Fax:781-647-0412
Practice Address - Street 1:65 GLEN RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3340
Practice Address - Country:US
Practice Address - Phone:617-524-4416
Practice Address - Fax:617-524-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0280324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility