NPIMap

Organization Active NPI

Brandon Residential Treatment Center, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Natick, MA
National Provider Identifier
1063570547
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
4903992 Issued in MA
Legal business name
BRANDON RESIDENTIAL TREATMENT CENTER, INC.
Practice address
27 Winter St
Natick, MA 01760-1015
Phone
(508) 655-6400
Fax
(508) 650-9431
NPI assigned
Dec 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Timothy M. Callahan, ED.D.
Title
Executive Director
Phone
(508) 655-6400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 4903992 MA Primary

Addresses

Primary practice location

27 Winter St
Natick, MA 01760-1015

Mailing address

27 Winter St
Natick, MA 01760-1015
Phone (508) 655-6400

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2311268Brandon Residential Treatment Center27 Winter St, Natick, MA 01760Certificate of waiverSep 18, 2026

National Provider Directory

National Provider Directory

Locations

27 Winter St
Natick, MA 01760
Phone (508) 655-6400

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063570547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 WINTER ST",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017601015",
            "telephone_number": "508-655-6400",
            "fax_number": "508-650-9431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 WINTER ST",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017601015",
            "telephone_number": "508-655-6400",
            "fax_number": "508-650-9431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON RESIDENTIAL TREATMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CALLAHAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "508-655-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MA",
            "license": "4903992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Natick, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.