Healthcare Provider Details

I. General information

NPI: 1205529955
Provider Name (Legal Business Name): COMMUNITY HEALTH PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 STOCKBRIDGE RD.
GREAT BARRINGTON MA
01230
US

IV. Provider business mailing address

P.O. BOX 30
GREAT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-428-9311
  • Fax:
Mailing address:
  • Phone: 413-528-9311
  • Fax: 413-664-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN JOHNSON
Title or Position: CHIEF HUMAN RESOURCE OFFICER AND CO
Credential: CHRO,CO
Phone: 413-528-9311