Provider Demographics
NPI:1184769069
Name:NONOTUCK RESOURCE ASSOCIATES, INC
Entity type:Organization
Organization Name:NONOTUCK RESOURCE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:FLEISCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:413-586-5256
Mailing Address - Street 1:40 MAIN STREET, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062
Mailing Address - Country:US
Mailing Address - Phone:413-586-5256
Mailing Address - Fax:413-584-2883
Practice Address - Street 1:40 MAIN STREET, SUITE 1
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062
Practice Address - Country:US
Practice Address - Phone:413-586-5256
Practice Address - Fax:413-584-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1905686Medicaid