Healthcare Provider Details

I. General information

NPI: 1558557587
Provider Name (Legal Business Name): COMMUNITY HEALTHLINK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

IV. Provider business mailing address

20 OLDE COLONIAL DR APT 6
GARDNER MA
01440-4212
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1000
  • Fax:
Mailing address:
  • Phone: 978-273-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. GLEN VICTOR POWELL
Title or Position: COUNSELOR
Credential: M.S.
Phone: 978-466-8350