Provider Demographics
NPI:1184812463
Name:WEDIKO CHILDREN'S SERVICES
Entity type:Organization
Organization Name:WEDIKO CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:617-292-9200
Mailing Address - Street 1:72 E DEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2315
Mailing Address - Country:US
Mailing Address - Phone:617-292-9200
Mailing Address - Fax:617-292-9275
Practice Address - Street 1:11 BOBCAT BLVD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NH
Practice Address - Zip Code:03244-7419
Practice Address - Country:US
Practice Address - Phone:603-478-5236
Practice Address - Fax:603-478-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2899322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children