Provider Demographics
NPI:1811381437
Name:NERHC, INC
Entity Type:Organization
Organization Name:NERHC, INC
Other - Org Name:NEW ENGLAND REGIONAL HEADACHE CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:SN
Authorized Official - Phone:508-890-5633
Mailing Address - Street 1:85 PRESCOTT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2610
Mailing Address - Country:US
Mailing Address - Phone:508-890-5633
Mailing Address - Fax:508-890-1125
Practice Address - Street 1:85 PRESCOTT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2610
Practice Address - Country:US
Practice Address - Phone:508-890-5633
Practice Address - Fax:508-890-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA168131364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0357677Medicaid
MANP221502Medicare PIN