Healthcare Provider Details

I. General information

NPI: 1871246769
Provider Name (Legal Business Name): IMMIGRANT COMMUNITY DEVELOPMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST STE 134
SPRINGFIELD MA
01104-2361
US

IV. Provider business mailing address

26 BEAUDRY ST
SPRINGFIELD MA
01151-1704
US

V. Phone/Fax

Practice location:
  • Phone: 413-291-9020
  • Fax:
Mailing address:
  • Phone: 413-291-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ABDILLAHI S HUSSEIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 413-291-9020