Provider Demographics
NPI:1710325923
Name:STAVROS CENTER FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:STAVROS CENTER FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:Z. SEREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-253-4236
Mailing Address - Street 1:210 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2704
Mailing Address - Country:US
Mailing Address - Phone:413-256-6692
Mailing Address - Fax:413-256-2630
Practice Address - Street 1:210 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2704
Practice Address - Country:US
Practice Address - Phone:413-256-6692
Practice Address - Fax:413-256-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management