Provider Demographics
NPI:1831228691
Name:MATSON COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:MATSON COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-343-6662
Mailing Address - Street 1:564 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-8011
Mailing Address - Country:US
Mailing Address - Phone:978-343-6662
Mailing Address - Fax:978-343-9108
Practice Address - Street 1:10 CASCADE ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4702
Practice Address - Country:US
Practice Address - Phone:978-345-6301
Practice Address - Fax:978-345-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1905660320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1905660Medicaid