Provider Demographics
NPI:1811618812
Name:HABIT OPCO LLC
Entity type:Organization
Organization Name:HABIT OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR 2 C
Authorized Official - Prefix:
Authorized Official - First Name:SHANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-312-3599
Mailing Address - Street 1:511 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2506
Mailing Address - Country:US
Mailing Address - Phone:413-733-3488
Mailing Address - Fax:
Practice Address - Street 1:511 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2506
Practice Address - Country:US
Practice Address - Phone:413-733-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder