Provider Demographics
NPI:1902176449
Name:STANLEY STREET TREATMENT AND RESOURCES, INC
Entity Type:Organization
Organization Name:STANLEY STREET TREATMENT AND RESOURCES, INC
Other - Org Name:SSTAR SOUTH END SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:508-675-1054
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-675-1054
Mailing Address - Fax:508-324-7777
Practice Address - Street 1:1010 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2855
Practice Address - Country:US
Practice Address - Phone:508-675-1054
Practice Address - Fax:508-324-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-F00000909-11-01261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4379OtherDPH CLINIC LICENSE
22D0938610OtherCLIA LAB