Healthcare Provider Details

I. General information

NPI: 1285171934
Provider Name (Legal Business Name): UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HIGHLAND ST
CLINTON MA
01510-1037
US

IV. Provider business mailing address

60 HOSPITAL RD
LEOMINSTER MA
01453-2205
US

V. Phone/Fax

Practice location:
  • Phone: 978-368-3000
  • Fax:
Mailing address:
  • Phone: 978-466-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateMA

VIII. Authorized Official

Name: JOHN E BRONHARD
Title or Position: TREASURER AND CFO
Credential:
Phone: 978-870-1550