Provider Demographics
NPI:1922174226
Name:ASPIRE DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:ASPIRE DEVELOPMENTAL SERVICES, INC.
Other - Org Name:NORTH SHORE INFANT TODDLER PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-593-2727
Mailing Address - Street 1:103 JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902
Mailing Address - Country:US
Mailing Address - Phone:781-593-2727
Mailing Address - Fax:781-593-2542
Practice Address - Street 1:103 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902
Practice Address - Country:US
Practice Address - Phone:781-593-2727
Practice Address - Fax:781-593-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1800566Medicaid
MAEI0022OtherBLUE CROSS BLUE SHIELD
MA000000021538OtherBMC HEALTHNET PLAN
MA612070OtherHARVARD PILGRIM HEALTH
MA0008021OtherNEIGHBORHOOD NHM & NHP
MA7903218OtherAETNA USH
MA36547OtherFALLON HEALTH PLAN
MA996264OtherNETWORK HEALTH PLAN
MA716096OtherTUFTS