Provider Demographics
NPI:1073853438
Name:WORCESTER COLLATION FOR PEOPLE LIVING WITH HIV & AIDS
Entity Type:Organization
Organization Name:WORCESTER COLLATION FOR PEOPLE LIVING WITH HIV & AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-797-2271
Mailing Address - Street 1:94 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1371
Mailing Address - Country:US
Mailing Address - Phone:508-797-2271
Mailing Address - Fax:
Practice Address - Street 1:94 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1371
Practice Address - Country:US
Practice Address - Phone:508-797-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251E00000XAgenciesHome Health