Basic Information
| Provider Information | |||||||||
| NPI: | 1376797225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR HUMAN DEVELOPMENT, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VIDS/EI PROGRAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 332 BIRNIE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137336624 | ||||||||
| FaxNumber: | 4134392109 | ||||||||
| Practice Location | |||||||||
| Address1: | 332 BIRNIE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137336624 | ||||||||
| FaxNumber: | 4134392109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 11/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOODWIN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 4134292247 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | MA | Y | Agencies | Early Intervention Provider Agency |
No ID Information.