=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437267671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HEALTH LINK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 MAPLE ST
-----------------------------------------------------
City | STURBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-347-2206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 MAPLE STREET P.O.BOX 993
-----------------------------------------------------
City | STURBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-347-2206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSCYH NURSE
-----------------------------------------------------
Name | MR. WILLIAM BRUCE CUNNINGHAM
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 508-860-1299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 354688
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------