Provider Demographics
NPI:1922486612
Name:THE NORTH EAST EDUCATIONAL AND DEVELOPMENTAL SUPPORT CENTER
Entity Type:Organization
Organization Name:THE NORTH EAST EDUCATIONAL AND DEVELOPMENTAL SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-216-0300
Mailing Address - Street 1:1120 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4739
Mailing Address - Country:US
Mailing Address - Phone:978-216-0300
Mailing Address - Fax:978-851-1030
Practice Address - Street 1:1120 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4739
Practice Address - Country:US
Practice Address - Phone:978-216-0300
Practice Address - Fax:978-851-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200835251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services