Provider Demographics
NPI:1578855813
Name:SUPPLEMENTAL HEALTH CARE
Entity Type:Organization
Organization Name:SUPPLEMENTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSITANT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:PRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:413-206-8383
Mailing Address - Street 1:150 RIVERBANK RD
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2517
Mailing Address - Country:US
Mailing Address - Phone:413-206-8383
Mailing Address - Fax:
Practice Address - Street 1:150 RIVERBANK RD
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2517
Practice Address - Country:US
Practice Address - Phone:413-206-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2159311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home