Provider Demographics
NPI:1477567451
Name:PRESCOTT HEALTH CARE
Entity Type:Organization
Organization Name:PRESCOTT HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:OCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-754-1803
Mailing Address - Street 1:130 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1903
Mailing Address - Country:US
Mailing Address - Phone:508-754-1803
Mailing Address - Fax:508-792-9713
Practice Address - Street 1:130 ELM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1903
Practice Address - Country:US
Practice Address - Phone:508-754-1803
Practice Address - Fax:508-792-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9708600Medicaid
MAM21096Medicare ID - Type UnspecifiedGROUP NUMBER