1780183913 NPI number — FAMILY HEALTH CENTER OF WORCESTER, INC.

Table of content: (NPI 1780183913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780183913 NPI number — FAMILY HEALTH CENTER OF WORCESTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CENTER OF WORCESTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WORCESTER EAST MIDDLE SCHOOL-SCHOOL BASED HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780183913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 QUEEN STREET
Provider Second Line Business Mailing Address:
CREDENTIALING-MEDICAL SERVICES
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01610-2473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-860-7962
Provider Business Mailing Address Fax Number:
508-860-7929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 GRAFTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01604-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-796-7037
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
JUSTINIANO-FRANZEL
Authorized Official First Name:
ALYDA
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR. PROVIDER RELATIONS & CRED.
Authorized Official Telephone Number:
508-860-7962

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  4669 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110020639B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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