NPIMap

Organization Active NPI

Commonwealth of Mass - DDS

Doing business as Fernald Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • Belmont, MA
National Provider Identifier
1306977822
Registry record updated Oct 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
COMMONWEALTH OF MASS - DDS
Doing business as
Fernald Developmental Center
Practice address
200 Trapelo Road
Belmont, MA 02452-6302
Phone
(781) 894-3600
NPI assigned
Mar 8, 2007
Last updated
Oct 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2009

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

Authorized official

Name
Jeanette Maillet
Title
Chief Financial Officer
Phone
(617) 727-5608

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

200 Trapelo Road
Belmont, MA 02452-6302

Mailing address

500 Harrison Ave
Boston, MA 02118-2439
Phone (617) 727-5608

Other identifiers 1

IdentifierTypeStateIssuer
0916307MedicaidMA

Other names 1

  • FERNALD DEVELOPMENTAL CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Worcester State147 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1306977822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HARRISON AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182439",
            "telephone_number": "617-727-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TRAPELO ROAD",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024526302",
            "telephone_number": "781-894-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF MASS - DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "MAILLET",
        "authorized_official_first_name": "JEANETTE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "617-727-5608"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0916307",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FERNALD DEVELOPMENTAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belmont, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.