Provider Demographics
NPI:1992001457
Name:MASHPEE SERVICE UNIT/INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:MASHPEE SERVICE UNIT/INDIAN HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GONSALVES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-477-0209
Mailing Address - Street 1:483 GREAT NECK ROAD SOUTH
Mailing Address - Street 2:BUILDING 001-ADMIN BUILDING
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649
Mailing Address - Country:US
Mailing Address - Phone:508-477-0209
Mailing Address - Fax:508-477-1936
Practice Address - Street 1:483 GREAT NECK ROAD SOUTH
Practice Address - Street 2:BUILDING 002-HEALTH CLINIC
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:508-477-0209
Practice Address - Fax:508-477-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2023-05-03
Deactivation Date:2023-03-21
Deactivation Code:
Reactivation Date:2023-05-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health