=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639945058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDI STAFF SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2023
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 HUBBARD AVE STE 15
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-984-7707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 HUBBARD AVE STE 15
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TEMIA MC CONNELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-984-7707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376G00000X
-----------------------------------------------------
Taxonomy Name | Nursing Home Administrator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------