Provider Demographics
NPI:1760719553
Name:PELHAM ACADEMY
Entity Type:Organization
Organization Name:PELHAM ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOUTH MENTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-274-6800
Mailing Address - Street 1:13 PELHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421
Mailing Address - Country:US
Mailing Address - Phone:781-274-6800
Mailing Address - Fax:781-274-0900
Practice Address - Street 1:13 PELHAM RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5707
Practice Address - Country:US
Practice Address - Phone:781-274-6800
Practice Address - Fax:781-274-0900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSTICE RESOURCE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children