Provider Demographics
NPI:1023432564
Name:FOUR COUNTY WEST, INC.
Entity type:Organization
Organization Name:FOUR COUNTY WEST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:DETMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-385-0012
Mailing Address - Street 1:16 CENTER ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3589
Mailing Address - Country:US
Mailing Address - Phone:413-385-0012
Mailing Address - Fax:413-385-0014
Practice Address - Street 1:360 SEWALL ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2711
Practice Address - Country:US
Practice Address - Phone:413-385-0012
Practice Address - Fax:413-385-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8201251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health