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General NPI Number Information
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NPI Number | 1578855813
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTH CARE
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 150 RIVERBANK RD
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2517
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Country | US
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Telephone | 413-206-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 150 RIVERBANK RD
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2517
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Country | US
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Telephone | 413-206-8383
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPY ASSITANT
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Name | LINDA KAREN PRELLA
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Credential | COTA/L
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Telephone | 413-206-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 2159
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License Number State | MA
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