Provider Demographics
NPI:1184492555
Name:FITCHBURG COMPREHENSIVE TREATMENT CENTER OPIOID USE DISORDER PROGRAM
Entity type:Organization
Organization Name:FITCHBURG COMPREHENSIVE TREATMENT CENTER OPIOID USE DISORDER PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISPENSING NURSE NON-EXEMPT L C
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:508-333-9322
Mailing Address - Street 1:155 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-8142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8142
Practice Address - Country:US
Practice Address - Phone:978-343-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone