Provider Demographics
NPI:1376673111
Name:THE GERIATRIC AUTHORITY OF HOLYOKE
Entity Type:Organization
Organization Name:THE GERIATRIC AUTHORITY OF HOLYOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:RONDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-536-8110
Mailing Address - Street 1:45 LOWER WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2747
Mailing Address - Country:US
Mailing Address - Phone:413-536-8110
Mailing Address - Fax:413-538-9875
Practice Address - Street 1:45 LOWER WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2747
Practice Address - Country:US
Practice Address - Phone:413-536-8110
Practice Address - Fax:413-538-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1706624Medicaid
MA1900129Medicaid