Basic Information
| Provider Information | |||||||||
| NPI: | 1871512814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COOLEY DICKINSON HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | P.O. BOX 5001 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822000 | ||||||||
| FaxNumber: | 4135822680 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822000 | ||||||||
| FaxNumber: | 4135822680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 01/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | MARQUESEE | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4135822212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 2155 | MA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 900170 | 01 | MA | HARVARD PILGRIM HEALTH PL | OTHER | 25114600 | 01 | MA | MERIT BEHAVIORAL HEALTH | OTHER | 900390 | 01 | MA | TUFTS OUTPATIENT BEHAV HE | OTHER | 1004880 | 01 | MA | BEACON HEALTH | OTHER | 001267 | 01 | MA | VALUE OPTIONS | OTHER | 000000020630 | 01 | MA | BMC HEALTHNET | OTHER | 1010476 | 05 | MA | MEDICAID | 1308823 | 05 | MA | MEDICAID | 1310224 | 05 | MA | MEDICAID |