Provider Demographics
NPI:1700152006
Name:LEMUEL SHATTUCK HOSPITAL
Entity Type:Organization
Organization Name:LEMUEL SHATTUCK HOSPITAL
Other - Org Name:HOPE/FOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADDICTIONS CLINICAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC-II, CADC
Authorized Official - Phone:617-971-3781
Mailing Address - Street 1:57 STRATTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2916
Mailing Address - Country:US
Mailing Address - Phone:617-288-6139
Mailing Address - Fax:
Practice Address - Street 1:170 MORTON ST.
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-971-3781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1453AD251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management