PINE STREET INN, INC. (NPI# 1639337280) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639337280 |
| Entity Type | Organization |
| Organization Name | PINE STREET INN, INC. |
| Practice Address |
28 Rockwell St Dorchester Center MA 02124-4438 |
| Mailing Address |
444 Harrison Ave Boston MA 02118-2404 |
| Practice Telephone | 6178928802 |
| Practice Fax Number | 6178259020 |
| Mailing Telephone | 6174824944 |
| Mailing Fax Number | 6174511890 |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2008-05-30 |
| Authorized Official Name | MR. TERRENCE B GAGNE (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 6178929116 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 1803492 | 05 |
| Street Address |
28 ROCKWELL ST |
| City | DORCHESTER CENTER |
| State | MA |
| Zip Code | 02124-4438 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679109599 | Yolanda Barner | Behavioral Analyst | 241 Norfolk St, Dorchester, MA 02124 | 2020-03-23 |
| 1144878489 | Marissa Sneed | Case Manager/Care Coordinator | 1059 Tremont St Suit 2, Roxbury Crossing, ME 02124 | 2019-08-29 |
| 1407413487 | Adrian Velasquez Md LLC | Internal Medicine | 2110 Dorchester Ave Ste 205, Seton Building, Dorchester, MA 02124 | 2019-05-24 |
| 1164908794 | Genesis 365 Care LLC | Home Health Aide | 114 Fuller St # 1, Dorchester, MA 02124 | 2018-07-17 |
| 1821581422 | Prince Nwaford | Psychologist | 176 Harvard Street, 2, Boston, MA 02124 | 2018-06-08 |
| 1073026753 | Massachusetts Chiropractic Center LLC | Chiropractor | 879-881 Blue Hill Avenue, Dorchester, MA 02124 | 2017-11-16 |
| 1770096620 | Aly Tran | Behavior Technician | 232 Centre St, Dorchester, MA 02124 | 2017-11-14 |
| 1326564386 | Mildred R Gomez | Community Health Worker | 108 Norfolk St, Dorchester, MA 02124 | 2017-08-21 |
| 1871025585 | Dwight Dorcy | Assistant Behavior Analyst | 7 Samoset St # 3, Dorchester, MA 02124 | 2017-03-31 |
| 1346793452 | Jennie Lee | Nurse Practitioner | 425 Harvard St, Dorchester, MA 02124 | 2016-07-26 |
| Find all providers in zip 02124 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225588494 | Afia Ayiwa-mensah | Residential Treatment Facility, Physical Disabilities | 58 Savoy Ave, Springfield, MA 01104-2008 | 2016-10-11 |
| 1245675776 | Preferred Adult Foster Care | Residential Treatment Facility, Physical Disabilities | 218 Shove St, Fall River, MA 02724-2018 | 2013-05-10 |
| 1356593743 | Supplemantal Health Care Services | Residential Treatment Facility, Physical Disabilities | 731 Truman Hwy, Hyde Park, MA 02136 | 2008-10-16 |
| 1376795781 | Advocates, Inc. | Residential Treatment Facility, Physical Disabilities | 7 Oakland Sreet, Lexington, MA 02420-3605 | 2008-10-16 |
| 1215491618 | Town of Petersham | Residential Treatment Facility, Physical Disabilities | 31 Spring St, Petersham, MA 01366 | 2019-01-30 |
| 1316483910 | New England Deaconess Association | Residential Treatment Facility, Physical Disabilities | 80 Deaconess Rd, Concord, MA 01742-4168 | 2017-01-06 |
| 1003285545 | Veteran Homestead, Inc. | Residential Treatment Facility, Physical Disabilities | 69 High St, Fitchburg, MA 01420-7508 | 2015-09-15 |
| 1962635847 | Uptown Physical Therapy | Residential Treatment Facility, Physical Disabilities | 668 Salem St, Malden, MA 02148-4363 | 2009-08-26 |
| 1639304926 | Meridians Centre for Massage, Inc. | Residential Treatment Facility, Physical Disabilities | 515 Bridge St, N Weymouth, MA 02191-1420 | 2009-05-15 |
| 1588843148 | Advocates, Inc. | Residential Treatment Facility, Physical Disabilities | 17 Warren Ave, Woburn, MA 01801-4936 | 2007-10-31 |
| Find all providers with the same taxonomy | ||||
| City | DORCHESTER CENTER |
| Zip Code | 02124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.