Provider Demographics
NPI:1063546885
Name:TOWN OF MANCHESTER BY THE SEA
Entity type:Organization
Organization Name:TOWN OF MANCHESTER BY THE SEA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CREHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-526-7385
Mailing Address - Street 1:10 CENTRAL ST
Mailing Address - Street 2:TOWN HALL, SECOND FLOOR, ROOM 8
Mailing Address - City:MANCHESTER BY THE SEA
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1399
Mailing Address - Country:US
Mailing Address - Phone:978-526-7385
Mailing Address - Fax:978-526-2009
Practice Address - Street 1:10 CENTRAL ST
Practice Address - Street 2:TOWN HALL, SECOND FLOOR, ROOM 8
Practice Address - City:MANCHESTER BY THE SEA
Practice Address - State:MA
Practice Address - Zip Code:01944-1399
Practice Address - Country:US
Practice Address - Phone:978-526-7385
Practice Address - Fax:978-526-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN64577174400000X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11005Medicare PIN