Provider Demographics
NPI:1356526297
Name:WHATELY HEALTH CENTER
Entity type:Organization
Organization Name:WHATELY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:FERRANTI
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:413-665-0176
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:WHATELY
Mailing Address - State:MA
Mailing Address - Zip Code:01093-0205
Mailing Address - Country:US
Mailing Address - Phone:413-665-0176
Mailing Address - Fax:413-397-9760
Practice Address - Street 1:181 STATE ROAD
Practice Address - Street 2:
Practice Address - City:WHATELY
Practice Address - State:MA
Practice Address - Zip Code:01093
Practice Address - Country:US
Practice Address - Phone:413-665-0176
Practice Address - Fax:413-397-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169563261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2260OtherMEDICARE INDIVIDUAL
MA9709444Medicaid
MA9709444Medicaid