Provider Demographics
NPI:1396066817
Name:HABIT OPCO
Entity type:Organization
Organization Name:HABIT OPCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGARCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-523-2214
Mailing Address - Street 1:205 PORTLAND ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1721
Mailing Address - Country:US
Mailing Address - Phone:617-523-2214
Mailing Address - Fax:
Practice Address - Street 1:155 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8142
Practice Address - Country:US
Practice Address - Phone:978-343-6300
Practice Address - Fax:978-343-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2012-12-28
Deactivation Date:2011-11-01
Deactivation Code:
Reactivation Date:2012-12-28
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health