Provider Demographics
NPI:1841427101
Name:SALEM STREET HEALTHCARE INC
Entity Type:Organization
Organization Name:SALEM STREET HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:978-452-9229
Mailing Address - Street 1:285 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3517
Mailing Address - Country:US
Mailing Address - Phone:978-452-9229
Mailing Address - Fax:978-452-3752
Practice Address - Street 1:285 SALEM ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3517
Practice Address - Country:US
Practice Address - Phone:978-452-9229
Practice Address - Fax:978-452-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230249261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health