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WALNUT STREET CENTER INC NPI 1962532861


NPI Information

NPI: 1962532861
Provider Name: WALNUT STREET CENTER, INC
Classification: Day Training, Developmentally Disabled Services - 251C00000X
Entity Type: Organization

CLIA Number: 22D1062126

Address:
71 LINWOOD ST
SOMERVILLE, MA
ZIP 02143
Phone: (617) 776-1448
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WALNUT STREET CENTER, INC is a day training developmentally disabled services in Somerville, MA. The provider is these agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. WALNUT STREET CENTER, INC NPI is 1962532861. The provider is registered as an organization entity type.

The provider's business location address is:

71 LINWOOD ST
SOMERVILLE, MA
ZIP 02143-112
Phone: (617) 776-1448
Fax: (617) 629-3568

The provider's authorized official is John D Keegan .
The authorized official title is Executive Director and has the following contact phone number (617) 776-1448.

The CLIA number assigned to this NPI record is 22D1062126 - other - group home for intel dis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/7/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251C00000XDay Training, Developmentally Disabled ServicesYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11317555MEDICAIDMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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