| Organization Name: | PENIKESE ISLAND SCHOOL, INC |
| NPI Number: | 1346641313 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MANDI KOSAKOWSKI (ADMINISTRATOR/THIRD PARTY BILLING) |
| Mailing Address: | 565 Woods Hole Rd Woods Hole |
| State: | MA US |
| Postal Code: | 025431041 |
| Phone Number: | 5085487276 |
| Fax Number: | 5084579580 |
| NPI Enumeration Date: | 09/10/2014 |
| NPI Last Update Date: | 09/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | 0203 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |