Provider Demographics
NPI:1376696674
Name:FALLON COMMUNITY HEALTH PLAN
Entity Type:Organization
Organization Name:FALLON COMMUNITY HEALTH PLAN
Other - Org Name:SUMMIT ELDERCARESM
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-368-9499
Mailing Address - Street 1:10 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2898
Mailing Address - Country:US
Mailing Address - Phone:508-368-9437
Mailing Address - Fax:508-754-1931
Practice Address - Street 1:277 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1207
Practice Address - Country:US
Practice Address - Phone:508-852-2026
Practice Address - Fax:508-856-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1803247251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1803247Medicaid
MA1803247Medicaid