Provider Demographics
NPI:1790385631
Name:DYNAMIC SUPPORT TEAM LLC
Entity Type:Organization
Organization Name:DYNAMIC SUPPORT TEAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAINARD
Authorized Official - Middle Name:NGIGI
Authorized Official - Last Name:HINGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-551-5167
Mailing Address - Street 1:20 COMMERCIAL DR STE 2013
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2837
Mailing Address - Country:US
Mailing Address - Phone:978-551-5167
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2837
Practice Address - Country:US
Practice Address - Phone:978-258-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services