Provider Demographics
NPI:1962817387
Name:STEVENS-CHILDREN'S HOME, INC.
Entity Type:Organization
Organization Name:STEVENS-CHILDREN'S HOME, INC.
Other - Org Name:STEVENS TREATMENT PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-679-0183
Mailing Address - Street 1:24 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4620
Mailing Address - Country:US
Mailing Address - Phone:508-679-0183
Mailing Address - Fax:508-679-1950
Practice Address - Street 1:24 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4620
Practice Address - Country:US
Practice Address - Phone:508-679-0183
Practice Address - Fax:508-679-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9010560322D00000X
MA9010559322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children