Provider Demographics
NPI:1184151508
Name:SHIFA COMPREHENSIVE HEALTH CENTER
Entity type:Organization
Organization Name:SHIFA COMPREHENSIVE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZUHAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-348-4343
Mailing Address - Street 1:185 WEST AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1700
Mailing Address - Country:US
Mailing Address - Phone:413-610-2201
Mailing Address - Fax:
Practice Address - Street 1:185 WEST AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1700
Practice Address - Country:US
Practice Address - Phone:413-610-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110107718AMedicaid