Provider Demographics
NPI:1851477491
Name:THE COMMONWEALTH OF MASSACHUSETTS
Entity Type:Organization
Organization Name:THE COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:CAPE COD AND ISLANDS COMMUNITY MENTAL HEALTH CENTER-IPD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-564-9628
Mailing Address - Street 1:830 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-2110
Mailing Address - Country:US
Mailing Address - Phone:508-564-9600
Mailing Address - Fax:508-564-9700
Practice Address - Street 1:830 COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-2110
Practice Address - Country:US
Practice Address - Phone:508-564-9600
Practice Address - Fax:508-564-9700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAEXEMPT283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACAP2222401901OtherBLUE CROSS/BLUE SHIELD
MA110000084FMedicaid
MAY10407Medicare ID - Type UnspecifiedPROFESSIONAL GROUP
MA224031Medicare ID - Type Unspecified