Provider Demographics
NPI:1679302517
Name:EPIPHANY WELLNESS MASSACHUSETTS LLC
Entity type:Organization
Organization Name:EPIPHANY WELLNESS MASSACHUSETTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DENGLEGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-221-0297
Mailing Address - Street 1:257 TURNPIKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:257 TURNPIKE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1791
Practice Address - Country:US
Practice Address - Phone:848-221-0297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health