Provider Demographics
NPI: | 1558181487 |
---|---|
Name: | COMMUNITY HEALTH PROGRAMS, INC |
Entity type: | Organization |
Organization Name: | COMMUNITY HEALTH PROGRAMS, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BETHANY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KIELEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 413-528-9311 |
Mailing Address - Street 1: | PO BOX 30 |
Mailing Address - Street 2: | |
Mailing Address - City: | GREAT BARRINGTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01230-0030 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 413-528-9311 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 444 STOCKBRIDGE RD |
Practice Address - Street 2: | |
Practice Address - City: | GREAT BARRINGTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01230-1295 |
Practice Address - Country: | US |
Practice Address - Phone: | 413-528-9311 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-10-15 |
Last Update Date: | 2024-10-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |