Provider Demographics
NPI:1992368153
Name:MCAULEY NAZARETH HOME FOR BOYS, INC.
Entity Type:Organization
Organization Name:MCAULEY NAZARETH HOME FOR BOYS, INC.
Other - Org Name:NAZARETH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-892-4886
Mailing Address - Street 1:77 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1011
Mailing Address - Country:US
Mailing Address - Phone:508-892-4886
Mailing Address - Fax:508-892-9736
Practice Address - Street 1:77 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1011
Practice Address - Country:US
Practice Address - Phone:508-892-4886
Practice Address - Fax:508-892-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty