Organization · NPI-2

128 Medical Group LLC

Clinic/Center, Rehabilitation, Substance Use Disorder · Concord, MA

NPI number1881492759
StatusActive
Last updated in NPPESJul 23, 2026

Details

NPI
1881492759
Entity type
Organization (NPI-2)
Legal business name
128 Medical Group LLC
Organization subpart
No
Enumeration date
Mar 5, 2025
Certification date
Jul 23, 2026
Last updated
Jul 23, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder––Yes
261QM0850X Clinic/Center, Adult Mental Health––

Other names

  • Create Health And Wellness (Doing Business As)

Practice location

192 Sudbury Rd
Concord, MA 01742-3420

Phone 978-804-7844

Mailing address

192 Sudbury Rd
Concord, MA 01742-3420

Authorized official

David Hanley
Billing
9788047844

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