Provider Demographics
NPI:1679913990
Name:LOWELL HOUSE SOAP PROGRAM
Entity type:Organization
Organization Name:LOWELL HOUSE SOAP PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LADC
Authorized Official - Phone:978-454-2997
Mailing Address - Street 1:555 E MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1448
Mailing Address - Country:US
Mailing Address - Phone:978-454-2997
Mailing Address - Fax:978-937-2559
Practice Address - Street 1:555 E MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1448
Practice Address - Country:US
Practice Address - Phone:978-454-2997
Practice Address - Fax:978-937-2559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOWELL HOUSE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder