SRC West Springfield, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0068 Issued in MA

Legal business name

SRC WEST SPRINGFIELD, INC.

Practice address

42 Prospect Ave
West Springfield, MA 01089-4510

Phone

(413) 733-3151

Fax

(413) 731-9984

NPI assigned

May 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tamilyn M. Levin, ESQ.

Title

Cfo

Phone

(781) 707-9510

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Wingate at West Springfield Rehab. & Skilled Nsg. Residence Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1336190867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 KENDRICK ST",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024942708",
            "telephone_number": "781-707-9085",
            "fax_number": "781-707-9285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 PROSPECT AVE",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010894510",
            "telephone_number": "413-733-3151",
            "fax_number": "413-731-9984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRC WEST SPRINGFIELD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "LEVIN",
        "authorized_official_first_name": "TAMILYN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "781-707-9510",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026486B",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0927481",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wingate at West Springfield Rehab. & Skilled Nsg. Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tania K Spear, RN
• Speech and Language Center
• Ryan Alan Spencer
• Frederick Walker Sperry, M.S.W., L.I.C.S.W.
• Victoria E Springer
• Lydia Srnka
• Danielle St Jacques
• Robert Joseph St Marie, RPH
• Donna M. St. Pierre, CRNA
• St.Joseph'S Family Dental,LLC

• Skilled Nursing Facility in West Springfield, MA
• Providers in West Springfield, MA by specialty
• Skilled Nursing Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.