Basic Information
| Provider Information | |||||||||
| NPI: | 1194706184 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHERN BERKSHIRE COMMUNITY SERVICES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | SWEET BROOK TRANSITIONAL CARE & LIVING CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1561 COLD SPRING RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012672743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134588127 | ||||||||
| FaxNumber: | 4134588209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1561 COLD SPRING RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012672743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134588127 | ||||||||
| FaxNumber: | 4134588209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAND | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | FINANCIAL SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4134588127 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 3973 | MA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0925608 | 05 | MA | MEDICAID |