Basic Information
| Provider Information | |||||||||
| NPI: | 1720647209 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY HEALTH CENTER OF WORCESTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY HEALTH CENTER-HOAP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 QUEEN STREET | ||||||||
| Address2: | CREDENTIALING DEPT | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016102473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088607962 | ||||||||
| FaxNumber: | 5087967014 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 CHANDLER ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016093088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088607888 | ||||||||
| FaxNumber: | 5087967053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2019 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | JUSTINIANO-FRANZEL | ||||||||
| AuthorizedOfficialFirstName: | ALYDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER OF PROVIDER RELATIONS/CRED. | ||||||||
| AuthorizedOfficialTelephone: | 5088607962 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAMILY HEALTH CENTER OF WORCESTER, INC. | ||||||||
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| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.