Provider Demographics
NPI:1841469178
Name:THE ASSOCIATION FOR COMMUNITY LIVING
Entity type:Organization
Organization Name:THE ASSOCIATION FOR COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-732-0531
Mailing Address - Street 1:1 CARANDO DR STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3211
Mailing Address - Country:US
Mailing Address - Phone:413-732-0531
Mailing Address - Fax:413-732-1168
Practice Address - Street 1:1 CARANDO DR STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3211
Practice Address - Country:US
Practice Address - Phone:413-732-0531
Practice Address - Fax:413-732-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA004021251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1906631OtherMASSHEALTH