1306034244 NPI number — SILVER SPRING HEALTH CARE MANAGEMENT, INC

Table of content: (NPI 1306034244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306034244 NPI number — SILVER SPRING HEALTH CARE MANAGEMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER SPRING HEALTH CARE MANAGEMENT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306034244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/18/2019
NPI Reactivation Date:
03/27/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 KENYON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02879-4216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-788-3929
Provider Business Mailing Address Fax Number:
401-788-3939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 KENYON AVE STE L10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02879-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-788-1638
Provider Business Practice Location Address Fax Number:
401-782-9892
Provider Enumeration Date:
10/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POLHEMUS
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
401-788-1974

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD07065 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD07065 . This is a "LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: NPP37418 . This is a "RI MEDICAL LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".