National Provider Identifier Database

DEPARTMENT OF MENTAL HEALTH
Community Based Residential Treatment Facility, Mental Illness

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.


Contact Information

DEPARTMENT OF MENTAL HEALTH
TEWKSBURY STATE HOSP SPECIAL BLDG - MERRIMACK CTR BIRTP
365 EAST ST
TEWKSBURY, MA01876
Phone: 978-858-3776
Fax: 978-858-3494
Website:
Specialty Taxonomy Code
* Community Based Residential Treatment Facility, Mental Illness 320800000X

* Indicates primary specialty

NPI Profile & details for DEPARTMENT OF MENTAL HEALTH

NPI Number 1710004320
Legal business name
LBN
DEPARTMENT OF MENTAL HEALTH
Authorized official PAUL SCOPA - (ASST. DIRECTOR OF NON-INST REIMBURS)
Entity Organization
Organization subpart No
Enumeration date 03/26/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • MA Medicaid: 1199234

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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