Healthcare Provider Details

I. General information

NPI: 1992880736
Provider Name (Legal Business Name): BAYSTATE WING HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/27/2023
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WRIGHT ST
PALMER MA
01069-1138
US

IV. Provider business mailing address

40 WRIGHT ST
PALMER MA
01069-1138
US

V. Phone/Fax

Practice location:
  • Phone: 413-283-7651
  • Fax: 413-284-5117
Mailing address:
  • Phone: 413-370-5285
  • Fax: 413-370-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number2181
License Number StateMA

VIII. Authorized Official

Name: RAYMOND MCCARTHY
Title or Position: SR. VP, CFO & TREASURER BH
Credential:
Phone: 413-794-3290