Provider Demographics
NPI:1477689388
Name:CHRISTOPHER HOUSE ASSISTED LIVING ,LP
Entity Type:Organization
Organization Name:CHRISTOPHER HOUSE ASSISTED LIVING ,LP
Other - Org Name:CHRISTOPHER HEIGHTS OF WORCESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARON-WILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-792-1456
Mailing Address - Street 1:20 MARY SCANO DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2892
Mailing Address - Country:US
Mailing Address - Phone:508-792-1456
Mailing Address - Fax:508-792-3156
Practice Address - Street 1:20 MARY SCANO DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2892
Practice Address - Country:US
Practice Address - Phone:508-792-1456
Practice Address - Fax:508-792-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1903128Medicaid