Provider Demographics
NPI:1528573037
Name:HILLTOWN COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:HILLTOWN COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:JOHN P. MUSANTE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-238-5511
Mailing Address - Street 1:70 BOLTWOOD WALK
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2271
Mailing Address - Country:US
Mailing Address - Phone:413-238-5511
Mailing Address - Fax:
Practice Address - Street 1:70 BOLTWOOD WALK
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2271
Practice Address - Country:US
Practice Address - Phone:413-238-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4950261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16638OtherBCBS