Provider Demographics
NPI:1811473267
Name:DEVENS TREATMENT & RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:DEVENS TREATMENT & RECOVERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRUPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-615-5200
Mailing Address - Street 1:85 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:DEVENS
Mailing Address - State:MA
Mailing Address - Zip Code:01434-4401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 PATTON RD
Practice Address - Street 2:
Practice Address - City:DEVENS
Practice Address - State:MA
Practice Address - Zip Code:01434-4401
Practice Address - Country:US
Practice Address - Phone:978-615-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEVENS TREATMENT & RECOVERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty