1174541775 NPI number — SPRINGFIELD HOSPITAL

Table of content: SHELLEY F HERRERA (NPI 1962193037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174541775 NPI number — SPRINGFIELD HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGFIELD HOSPITAL
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:
THE WINDHAM CENTER FOR MENTAL HEALTH SERVICES
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:
1174541775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
252 RIVER STREET
Provider Second Line Business Mailing Address:
CO NETWORK MANAGEMENT SERVICES
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-885-5785
Provider Business Mailing Address Fax Number:
802-885-2030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 OLD TERRACE
Provider Second Line Business Practice Location Address:
THE WINDHAM CENTER FOR MENTAL HEALTH SERVICES
Provider Business Practice Location Address City Name:
BELLOWS FALLAS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-463-1292
Provider Business Practice Location Address Fax Number:
802-463-1290
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAROCHELLE
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
802-885-2151

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  678 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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