Provider Demographics
NPI:1861024432
Name:ATTLEBORO LODGE, INC
Entity Type:Organization
Organization Name:ATTLEBORO LODGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:ROSENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-408-9035
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4006
Mailing Address - Country:US
Mailing Address - Phone:781-408-9035
Mailing Address - Fax:508-639-5716
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-4006
Practice Address - Country:US
Practice Address - Phone:781-408-9035
Practice Address - Fax:508-639-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health