Provider Demographics
NPI:1558503342
Name:VIDADE CORPORATION
Entity type:Organization
Organization Name:VIDADE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MHA
Authorized Official - Prefix:MS
Authorized Official - First Name:VIDADE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RATEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-753-9760
Mailing Address - Street 1:1960 WASHINGTON ST
Mailing Address - Street 2:1960
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3219
Mailing Address - Country:US
Mailing Address - Phone:617-516-0280
Mailing Address - Fax:
Practice Address - Street 1:1960 WASHINGTON ST
Practice Address - Street 2:1960
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3219
Practice Address - Country:US
Practice Address - Phone:617-516-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization