Provider Demographics
NPI:1730622325
Name:SWEENEY DAWLEY RECOVERY CENTER, LLC.
Entity type:Organization
Organization Name:SWEENEY DAWLEY RECOVERY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NP-C
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:781-268-2638
Mailing Address - Street 1:639 GRANITE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5366
Mailing Address - Country:US
Mailing Address - Phone:781-724-6998
Mailing Address - Fax:
Practice Address - Street 1:639 GRANITE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5366
Practice Address - Country:US
Practice Address - Phone:781-724-6998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233425364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20535Medicare UPIN