Provider Demographics
NPI:1407086937
Name:SPRINGFIELD DEPT OF HEALTH & HUMAN SERVICES
Entity Type:Organization
Organization Name:SPRINGFIELD DEPT OF HEALTH & HUMAN SERVICES
Other - Org Name:HEALTH SVCS HOMELESS-DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAULTON-HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-787-6456
Mailing Address - Street 1:95 STATE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2073
Mailing Address - Country:US
Mailing Address - Phone:413-787-6456
Mailing Address - Fax:413-787-6458
Practice Address - Street 1:769 WORTHINGTON STREET
Practice Address - Street 2:HSH DENTAL CLINIC
Practice Address - City:SPRINGFELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1112
Practice Address - Country:US
Practice Address - Phone:413-731-9575
Practice Address - Fax:413-731-9575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF SPRINGFIELD, MA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312227Medicaid