Provider Demographics
NPI:1831471655
Name:SOUTH NORFOLK COUNTY ASSOCIATION FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:SOUTH NORFOLK COUNTY ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:781-762-4001
Mailing Address - Street 1:789 CLAPBOARDTREE ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1717
Mailing Address - Country:US
Mailing Address - Phone:781-762-4001
Mailing Address - Fax:781-461-5950
Practice Address - Street 1:789 CLAPBOARDTREE ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1717
Practice Address - Country:US
Practice Address - Phone:781-762-4001
Practice Address - Fax:781-461-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253J00000X253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027914BMedicaid
MA110027914AMedicaid
MA110027914DMedicaid