Provider Demographics
NPI:1992778781
Name:WALDEN BEHAVIORAL CARE LLC
Entity type:Organization
Organization Name:WALDEN BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-647-2929
Mailing Address - Street 1:51 SAWYER RD STE 510
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3448
Mailing Address - Country:US
Mailing Address - Phone:781-647-6705
Mailing Address - Fax:781-647-6755
Practice Address - Street 1:10 CAREMATRIX DR
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6149
Practice Address - Country:US
Practice Address - Phone:781-647-6700
Practice Address - Fax:781-647-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA679283Q00000X
283Q00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027437BMedicaid
MA1199471Medicaid