Provider Demographics
NPI:1457385460
Name:CARSON CENTER FOR HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:CARSON CENTER FOR HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-310-3301
Mailing Address - Street 1:20 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-2902
Mailing Address - Country:US
Mailing Address - Phone:413-572-4107
Mailing Address - Fax:413-572-4104
Practice Address - Street 1:20 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2902
Practice Address - Country:US
Practice Address - Phone:413-572-4107
Practice Address - Fax:413-572-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY10037Medicare PIN
MAY15127Medicare PIN
MAP10085Medicare PIN