Basic Information
| Provider Information | |||||||||
| NPI: | 1649293028 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTHLINK INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 72 JAQUES AVE | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016102476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088601163 | ||||||||
| FaxNumber: | 5088601115 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 QUEEN STREET | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088601260 | ||||||||
| FaxNumber: | 5088601115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | OSHLAG | ||||||||
| AuthorizedOfficialFirstName: | JORDAN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5088601163 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 2R006 | MA | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 324500000X | 0110 | MA | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QC1500X | 4684 | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 251S00000X | 4684 | MA | N | Agencies | Community/Behavioral Health | 261QM0801X | 4684 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1308076 | 05 | MA | MEDICAID | 1307002 | 05 | MA | MEDICAID | 1308742 | 05 | MA | MEDICAID | 1303007 | 05 | MA | MEDICAID |