Provider Demographics
NPI:1649293028
Name:COMMUNITY HEALTHLINK INC
Entity type:Organization
Organization Name:COMMUNITY HEALTHLINK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSHLAG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-860-1163
Mailing Address - Street 1:72 JAQUES AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2476
Mailing Address - Country:US
Mailing Address - Phone:508-860-1163
Mailing Address - Fax:508-860-1115
Practice Address - Street 1:12 QUEEN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-860-1260
Practice Address - Fax:508-860-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2R006320800000X
MA0110324500000X
MA4684261QC1500X, 251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308076Medicaid
MA1307002Medicaid
MA1308742Medicaid
MA1303007Medicaid
MA1308076Medicaid
MA1308742Medicaid