Provider Demographics
NPI:1124109053
Name:THE COMMONWEALTH OF MASSACHUSETTS
Entity type:Organization
Organization Name:THE COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUREAU DIRECTOR, PUBLIC HEALTH HOS
Authorized Official - Prefix:
Authorized Official - First Name:VALENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPTAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-784-9186
Mailing Address - Street 1:3 RANDOLPH ST.
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-0317
Mailing Address - Country:US
Mailing Address - Phone:781-828-2440
Mailing Address - Fax:781-821-4086
Practice Address - Street 1:3 RANDOLPH ST.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-0317
Practice Address - Country:US
Practice Address - Phone:781-828-2440
Practice Address - Fax:781-821-4086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110078194EMedicaid
MA1203371Medicaid