Provider Demographics
NPI:1366500498
Name:CHS OF WORCESTER, INC
Entity Type:Organization
Organization Name:CHS OF WORCESTER, INC
Other - Org Name:ST. MARY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLAMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-753-4791
Mailing Address - Street 1:39 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2433
Mailing Address - Country:US
Mailing Address - Phone:508-753-4791
Mailing Address - Fax:508-749-0023
Practice Address - Street 1:39 QUEEN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2433
Practice Address - Country:US
Practice Address - Phone:508-753-4791
Practice Address - Fax:508-749-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0782314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0924474Medicaid
MA0924474Medicaid