Provider Demographics
NPI:1225323777
Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Other - Org Name:GODDARD SCHOOL OF SCIENCE & TECHNOLOGY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR. PROVIDER RELATIONS/CRED
Authorized Official - Prefix:
Authorized Official - First Name:ALYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTINIANO-FRANZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-860-7962
Mailing Address - Street 1:14 RICHARDS ST
Mailing Address - Street 2:GODDARD HEALTH CENTER
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2609
Mailing Address - Country:US
Mailing Address - Phone:508-757-3401
Mailing Address - Fax:508-757-3492
Practice Address - Street 1:14 RICHARDS ST
Practice Address - Street 2:GODDARD HEALTH CENTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2609
Practice Address - Country:US
Practice Address - Phone:508-757-3401
Practice Address - Fax:508-757-3492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CENTER OF WORCESTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-13
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4669261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)