NPIMap

Organization Active NPI

Wayside Youth & Family Support Network

  • Voluntary or Charitable Agency
  • Waltham, MA
National Provider Identifier
1669690467
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Voluntary or Charitable AgencyTaxonomy code 251V00000X
License
0592 Issued in MA
Legal business name
WAYSIDE YOUTH & FAMILY SUPPORT NETWORK
Practice address
118 Central St
Waltham, MA 02453-5465
Phone
(781) 891-0556
NPI assigned
Apr 24, 2007
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
Eric L Masi
Title
Ceo
Phone
(508) 879-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Voluntary or Charitable Agency 251V00000X 0592 MA Primary

Addresses

Primary practice location

118 Central St
Waltham, MA 02453-5465

Mailing address

75 Fountain St
Framingham, MA 01702-6210
Phone (508) 879-9800

Other identifiers 4

IdentifierTypeStateIssuer
6119935OtherMAHARVARD PILGRIM
8710897OtherMACIGNA
EI0019OtherMABLUE CROSS BLE SHIELD
1803689MedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
Wayside Youth and Family Support Network8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

118 Central St
Waltham, MA 02453
Phone (781) 891-0555

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669690467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FOUNTAIN ST",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017026210",
            "telephone_number": "508-879-9800",
            "fax_number": "508-875-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 CENTRAL ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024535465",
            "telephone_number": "781-891-0556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYSIDE YOUTH & FAMILY SUPPORT NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MASI",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "508-879-9800"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "MA",
            "license": "0592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "6119935",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8710897",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLE SHIELD",
            "identifier": "EI0019",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1803689",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.