Provider Demographics
NPI:1063438133
Name:STANLEY STREET TREATMENT AND RESOURCES, INC
Entity type:Organization
Organization Name:STANLEY STREET TREATMENT AND RESOURCES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTAFIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-675-1054
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-675-1054
Mailing Address - Fax:508-324-7777
Practice Address - Street 1:400 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-675-1054
Practice Address - Fax:508-324-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MA4379261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308858Medicaid
MA66-90265OtherUNITED HEALTHCARE
MADC6638OtherRAILROAD MEDICARE
MA725921OtherTUFTS
RISS04283Medicaid
MAGR 000000001438OtherBMC HEALTHNET
MA670270OtherTUFTS
MA66-90265OtherUNITED HEALTHCARE
MA670270OtherTUFTS
MA=========OtherCCC COMPAS
MAGR 000000001438OtherBMC HEALTHNET