1417980970 NPI number — COMMUNITY HEALTH ASSOCIATION OF RICHMOND AND WEST STOCKBRIDGE

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 1417980970 NPI number — COMMUNITY HEALTH ASSOCIATION OF RICHMOND AND WEST STOCKBRIDGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH ASSOCIATION OF RICHMOND AND WEST STOCKBRIDGE
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:
1417980970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
21 STATE LINE RD.
Provider Business Mailing Address City Name:
WEST STOCKBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-232-0122
Provider Business Mailing Address Fax Number:
413-232-0199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 STATE LINE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST STOCKBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-232-0122
Provider Business Practice Location Address Fax Number:
413-232-0199
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JARRETT
Authorized Official First Name:
EMILIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
413-232-0122

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0602337 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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