National Provider Identifier Database

COMMONWEALTH OF MASSACHUSETS
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

COMMONWEALTH OF MASSACHUSETS
131 EMERALD STREET
WRENTHAM, MA02093
Phone: 508-384-3114
Fax: 508-384-1619
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for COMMONWEALTH OF MASSACHUSETS

NPI Number 1134251366
Legal business name
LBN
COMMONWEALTH OF MASSACHUSETS
Authorized official DYLAN LATTIMORE - (DEPUTY COMMISSIONER FOR ADMINISTRAT)
Entity Organization
Organization subpart Yes
Enumeration date 03/12/2007
Last updated 03/19/2026 - About 3 months ago
Sole proprietor1 Not specified
Identifiers
  • MA License #: EXEMPT
  • MA Medicaid: 0916315
  • MA Medicaid: 110000087F

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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