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General NPI Number Information
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NPI Number | 1467727891
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Entity Type | Organization
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Legal Business Name | PROVIDENCE BEHAVIORAL HEALTH HOSPITAL
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 1233 MAIN ST
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City | HOLYOKE
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State | MA
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Zip | 01040-5381
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Country | US
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Telephone | 413-539-2931
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Fax | 413-493-2703
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Provider Business Mailing Address
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Address Line | 1233 MAIN ST
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City | HOLYOKE
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State | MA
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Zip | 01040-5381
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Country | US
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Telephone | 413-539-2931
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Fax | 413-493-2703
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Authorized Official
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Title or Position | SENIOR CLINICIAN
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Name | BIRNIE WILLIAM II
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Credential |
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Telephone | 413-493-2082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 116430
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License Number State | MA
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