Healthcare Provider Details

I. General information

NPI: 1255215927
Provider Name (Legal Business Name): THE COMMONWEALTH OF MASSACHUSETTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ELMS STREET
GREENFIELD MA
01301
US

IV. Provider business mailing address

160 ELMS STREET
GREENFIELD MA
01301
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-4014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GUERTIN
Title or Position: CHIEF OF STAFF
Credential:
Phone: 413-774-4014