Provider Demographics
NPI:1558130302
Name:COMMUNITY HEALTH PROGRAMS
Entity Type:Organization
Organization Name:COMMUNITY HEALTH PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PRESIDENT.CHIEF FINANCIAL
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-528-9311
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-664-0274
Practice Address - Street 1:CHP DENTAL MOBILE UNIT
Practice Address - Street 2:444 STOCKBRIDGE ROAD.
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-528-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH PROGRAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028131BMedicaid