Provider Demographics
NPI:1518948595
Name:HOLYOKE HEALTH CENTER, INC
Entity Type:Organization
Organization Name:HOLYOKE HEALTH CENTER, INC
Other - Org Name:CHICOPEE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-420-2110
Mailing Address - Street 1:PO BOX 6260
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01041-6260
Mailing Address - Country:US
Mailing Address - Phone:413-420-2222
Mailing Address - Fax:413-592-2324
Practice Address - Street 1:505 FRONT STREET
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1246
Practice Address - Country:US
Practice Address - Phone:413-420-2222
Practice Address - Fax:413-592-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4118261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1320874Medicaid
MA1320874Medicaid