Healthcare Provider Details

I. General information

NPI: 1538763156
Provider Name (Legal Business Name): SILVER SPRING HEALTH CARE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENYON AVE SCMG PSYCHIATRY & NEUROLOGY
WAKEFIELD RI
02879
US

IV. Provider business mailing address

PO BOX 229
WAKEFIELD RI
02880-0229
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-8000
  • Fax: 401-782-9867
Mailing address:
  • Phone: 401-788-8757
  • Fax: 401-782-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCIA T POLHEMUS
Title or Position: CONTROLLER
Credential:
Phone: 401-788-1974