Healthcare Provider Details

I. General information

NPI: 1669809125
Provider Name (Legal Business Name): MONTAGUE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AVENUE A
TURNERS FALLS MA
01376-1168
US

IV. Provider business mailing address

1 AVENUE A
TURNERS FALLS MA
01376-1168
US

V. Phone/Fax

Practice location:
  • Phone: 413-863-3200
  • Fax: 413-863-3225
Mailing address:
  • Phone: 413-863-3200
  • Fax: 413-863-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberRN217540
License Number StateMA

VIII. Authorized Official

Name: MS. GINA MARIE MCNEELY
Title or Position: HEALTH DIRECTO
Credential:
Phone: 413-863-3200