1679682934 NPI number — SANDISFIELD HEALTH GROUP, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679682934 NPI number — SANDISFIELD HEALTH GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDISFIELD HEALTH GROUP, LLC
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:
BERKSHIRE REHABILITATION AND SKILLED CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1679682934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDISFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01255-0216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-258-4731
Provider Business Mailing Address Fax Number:
413-258-4116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 SANDISFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDISFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01255-9621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-258-4731
Provider Business Practice Location Address Fax Number:
413-258-4116
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOZADJIAN
Authorized Official First Name:
BRODIE
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL OFFICE MANAGER
Authorized Official Telephone Number:
413-441-5082

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0940038 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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