Provider Demographics
NPI:1952034126
Name:CHARLES RIVER OPTIMAL WELLNESS, LLC
Entity Type:Organization
Organization Name:CHARLES RIVER OPTIMAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FINANCIAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-557-4831
Mailing Address - Street 1:75 NORUMBEGA RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2431
Mailing Address - Country:US
Mailing Address - Phone:508-302-3074
Mailing Address - Fax:508-302-3074
Practice Address - Street 1:75 NORUMBEGA RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2431
Practice Address - Country:US
Practice Address - Phone:781-557-4831
Practice Address - Fax:508-302-3074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES RIVER OPTIMAL WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility