Provider Demographics
NPI:1891441069
Name:MANDALA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MANDALA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-599-2388
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-0136
Mailing Address - Country:US
Mailing Address - Phone:978-505-1949
Mailing Address - Fax:508-599-2389
Practice Address - Street 1:18 LYMAN ST STE 245
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1459
Practice Address - Country:US
Practice Address - Phone:508-599-2388
Practice Address - Fax:508-599-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty