Healthcare Provider Details

I. General information

NPI: 1518946904
Provider Name (Legal Business Name): HILLTOWN COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 RUSSELL RD
HUNTINGTON MA
01050-9777
US

IV. Provider business mailing address

73 RUSSELL RD
HUNTINGTON MA
01050-9777
US

V. Phone/Fax

Practice location:
  • Phone: 413-667-3009
  • Fax: 413-667-8746
Mailing address:
  • Phone: 413-667-3009
  • Fax: 413-667-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number4950
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ELIZA B. LAKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 413-238-5511