Provider Demographics
NPI:1306034244
Name:SILVER SPRING HEALTH CARE MANAGEMENT, INC
Entity Type:Organization
Organization Name:SILVER SPRING HEALTH CARE MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:POLHEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-788-1974
Mailing Address - Street 1:100 KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4216
Mailing Address - Country:US
Mailing Address - Phone:401-788-3929
Mailing Address - Fax:401-788-3939
Practice Address - Street 1:70 KENYON AVE STE L10
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-788-1638
Practice Address - Fax:401-782-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2022-05-17
Deactivation Date:2019-03-18
Deactivation Code:
Reactivation Date:2019-03-27
Provider Licenses
StateLicense IDTaxonomies
RIMD07065208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD07065OtherLICENSE
RINPP37418OtherRI MEDICAL LICENSE
RIMD07065OtherLICENSE