Provider Demographics
NPI:1104819572
Name:TOWN OF BILLERICA
Entity type:Organization
Organization Name:TOWN OF BILLERICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-671-0900
Mailing Address - Street 1:19 NORFOLK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1911
Mailing Address - Country:US
Mailing Address - Phone:888-771-6115
Mailing Address - Fax:508-297-2699
Practice Address - Street 1:6 GOOD ST
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-1807
Practice Address - Country:US
Practice Address - Phone:978-671-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1707264Medicaid
MA441590702OtherRR MEDICARE
MA800097OtherTUFTS HEALTH PLAN
MA700597OtherHARVARD PILGRIM
MA7685691OtherAETNA
MA033959OtherBC/BS OF MASS
MA700597OtherHARVARD PILGRIM