National Provider Identifier Database

PINE STREET INN INC
Residential Treatment Facility, Physical Disabilities

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently.


Contact Information

PINE STREET INN, INC.
28 ROCKWELL ST
DORCHESTER CENTER, MA02124-4438
Phone: 617-892-8802
Fax: 617-825-9020
Website:
Specialty Taxonomy Code
* Residential Treatment Facility, Physical Disabilities 320700000X

* Indicates primary specialty

NPI Profile & details for PINE STREET INN, INC.

NPI Number 1639337280
Legal business name
LBN
PINE STREET INN, INC.
Authorized official TERRENCE GAGNE - (CHIEF FINANCIAL OFFICER)
Entity Organization
Organization subpart No
Enumeration date 05/30/2008
Last updated 05/30/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • MA Medicaid: 1803492

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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