Healthcare Provider Details

I. General information

NPI: 1861710055
Provider Name (Legal Business Name): PATIENT CENTERED MEDICAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 WOLLASTON ST
SPRINGFIELD MA
01119-1638
US

IV. Provider business mailing address

68 WOLLASTON ST
SPRINGFIELD MA
01119-1638
US

V. Phone/Fax

Practice location:
  • Phone: 413-782-0340
  • Fax: 413-782-0340
Mailing address:
  • Phone: 413-782-0340
  • Fax: 413-782-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8063
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberT81M
License Number StateMA

VIII. Authorized Official

Name: MS. ROSE-ANN GASKIN-RICE
Title or Position: PRESIDENT/CEO
Credential: MBA
Phone: 413-782-0340