Provider Demographics
NPI:1477679942
Name:TOWN OF BELMONT
Entity type:Organization
Organization Name:TOWN OF BELMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CONANT
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:617-993-5807
Mailing Address - Street 1:19 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478
Mailing Address - Country:US
Mailing Address - Phone:617-993-2610
Mailing Address - Fax:617-993-2611
Practice Address - Street 1:644 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-993-5400
Practice Address - Fax:617-993-5409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF BELMONT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1951971Medicaid
MA11003086313Medicaid