1437267671 NPI number — COMMUNITY HEALTH LINK

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 1437267671 NPI number — COMMUNITY HEALTH LINK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH LINK
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:
6
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:
1437267671
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:
9 MAPLE STREET
Provider Second Line Business Mailing Address:
P.O.BOX 993
Provider Business Mailing Address City Name:
STURBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-347-2206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STURBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-347-2206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUNNINGHAM
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PSCYH NURSE
Authorized Official Telephone Number:
508-860-1299

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  354688 , 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: 163WP0807X . This is a "PSYCHIATRIC/MENTAL HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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