Provider Demographics
NPI:1598998635
Name:EGREMONT BOARD OF HEALTH
Entity Type:Organization
Organization Name:EGREMONT BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-528-0182
Mailing Address - Street 1:171 EGREMONT PLAIN RD
Mailing Address - Street 2:P.O. BOX 368
Mailing Address - City:SOUTH EGREMONT
Mailing Address - State:MA
Mailing Address - Zip Code:01258
Mailing Address - Country:US
Mailing Address - Phone:413-528-0182
Mailing Address - Fax:413-528-5465
Practice Address - Street 1:171 EGREMONT PLAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTH EGREMONT
Practice Address - State:MA
Practice Address - Zip Code:01258-0000
Practice Address - Country:US
Practice Address - Phone:413-528-0182
Practice Address - Fax:413-528-5465
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF EGREMONT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2083P0901X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare