Provider Demographics
NPI:1831225572
Name:TOWN OF NORTH BROOKFIELD
Entity type:Organization
Organization Name:TOWN OF NORTH BROOKFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA MANAGEMENT SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RYEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-867-3166
Mailing Address - Street 1:10 NEW SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535
Mailing Address - Country:US
Mailing Address - Phone:508-867-3166
Mailing Address - Fax:508-867-8148
Practice Address - Street 1:10 NEW SCHOOL DR
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535-2012
Practice Address - Country:US
Practice Address - Phone:508-867-3166
Practice Address - Fax:508-867-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1953559Medicaid