Basic Information
Provider Information | |||||||||
NPI: | 1194195206 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMMUNITY HEALTH PROGRAMS, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CHP NORTH ADAMS FAMILY MEDICAL AND DENTAL CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O., BOX 30 | ||||||||
Address2: |   | ||||||||
City: | GREAT BARRINGTON | ||||||||
State: | MA | ||||||||
PostalCode: | 01230 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135289311 | ||||||||
FaxNumber: | 4136440274 | ||||||||
Practice Location | |||||||||
Address1: | 71 HOSPITAL AVENUE | ||||||||
Address2: | FLOOR 3 | ||||||||
City: | NORTH ADAMS | ||||||||
State: | MA | ||||||||
PostalCode: | 01247 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4136644088 | ||||||||
FaxNumber: | 4136636405 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/01/2015 | ||||||||
LastUpdateDate: | 02/05/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SPILIOTES | ||||||||
AuthorizedOfficialFirstName: | AMELIA | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 4135289311 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CEO | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QP2300X | 4COJ | MA | N |   | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QC1500X | 4COJ | MA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
ID | Type | State | Issuer | Description | 110028131N | 05 | MA |   | MEDICAID |