Provider Demographics
NPI:1568771004
Name:ELDER SERVICES OF WORCESTER AREA, INC
Entity Type:Organization
Organization Name:ELDER SERVICES OF WORCESTER AREA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTRAMAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-756-1545
Mailing Address - Street 1:411 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3339
Mailing Address - Country:US
Mailing Address - Phone:508-756-1545
Mailing Address - Fax:508-754-7771
Practice Address - Street 1:411 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3339
Practice Address - Country:US
Practice Address - Phone:508-756-1545
Practice Address - Fax:508-754-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1908863Medicaid