Healthcare Provider Details

I. General information

NPI: 1649293028
Provider Name (Legal Business Name): COMMUNITY HEALTHLINK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 QUEEN STREET
WORCESTER MA
01610
US

IV. Provider business mailing address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1260
  • Fax: 508-860-1115
Mailing address:
  • Phone: 508-860-1163
  • Fax: 508-860-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4684
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number4684
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4684
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number2R006
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0110
License Number StateMA

VIII. Authorized Official

Name: MR. JORDAN A. OSHLAG
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: LICSW
Phone: 508-860-1163