Provider Demographics
NPI:1437267671
Name:COMMUNITY HEALTH LINK
Entity Type:Organization
Organization Name:COMMUNITY HEALTH LINK
Other - Org Name:FLOW PACT
Other - Org Type:Other Name
Authorized Official - Title/Position:PSCYH NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-860-1299
Mailing Address - Street 1:9 MAPLE STREET
Mailing Address - Street 2:P.O.BOX 993
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566
Mailing Address - Country:US
Mailing Address - Phone:508-347-2206
Mailing Address - Fax:
Practice Address - Street 1:9 MAPLE ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566
Practice Address - Country:US
Practice Address - Phone:508-347-2206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA354688251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA163WP0807XOtherPSYCHIATRIC/MENTAL HEALTH