Provider Demographics
NPI:1760834287
Name:PREPARATORY REHABILITATION FOR INDIVIDUAL DEVELOPMENT AND EMPLOYMENT
Entity Type:Organization
Organization Name:PREPARATORY REHABILITATION FOR INDIVIDUAL DEVELOPMENT AND EMPLOYMENT
Other - Org Name:PRIDE INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-823-7134
Mailing Address - Street 1:3 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 MAPLE ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3012
Practice Address - Country:US
Practice Address - Phone:508-823-7134
Practice Address - Fax:508-824-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110027767251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027767Medicaid