Provider Demographics
NPI:1285171934
Name:UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
Entity type:Organization
Organization Name:UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRONHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-870-1550
Mailing Address - Street 1:60 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2205
Mailing Address - Country:US
Mailing Address - Phone:978-466-2000
Mailing Address - Fax:
Practice Address - Street 1:201 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1037
Practice Address - Country:US
Practice Address - Phone:978-368-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-19
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22S001Medicare Oscar/Certification