Provider Demographics
NPI:1902924095
Name:DIGHTON-REHOBOTH
Entity Type:Organization
Organization Name:DIGHTON-REHOBOTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-986-1785
Mailing Address - Street 1:2700 REGIONAL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-1923
Mailing Address - Country:US
Mailing Address - Phone:781-986-1785
Mailing Address - Fax:781-961-6999
Practice Address - Street 1:2700 REGIONAL RD
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764-1923
Practice Address - Country:US
Practice Address - Phone:781-986-1785
Practice Address - Fax:781-961-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1952196Medicaid