Provider Demographics
NPI:1558557587
Name:COMMUNITY HEALTHLINK
Entity Type:Organization
Organization Name:COMMUNITY HEALTHLINK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:978-466-8350
Mailing Address - Street 1:20 OLDE COLONIAL DR APT 6
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-4212
Mailing Address - Country:US
Mailing Address - Phone:978-273-8438
Mailing Address - Fax:
Practice Address - Street 1:72 JAQUES AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2476
Practice Address - Country:US
Practice Address - Phone:508-860-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health