Provider Demographics
NPI:1568632040
Name:KENNEDY DONOVAN CENTER, INC
Entity Type:Organization
Organization Name:KENNEDY DONOVAN CENTER, INC
Other - Org Name:KENNEDY DONOVAN DAY HABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RODMAN
Authorized Official - Last Name:CONARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-543-2542
Mailing Address - Street 1:1 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2530
Mailing Address - Country:US
Mailing Address - Phone:508-543-2542
Mailing Address - Fax:508-543-9488
Practice Address - Street 1:19 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4938
Practice Address - Country:US
Practice Address - Phone:508-992-4756
Practice Address - Fax:508-999-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026352IMedicaid