Provider Demographics
NPI:1780183913
Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Other - Org Name:WORCESTER EAST MIDDLE SCHOOL-SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR. PROVIDER RELATIONS & CRED.
Authorized Official - Prefix:
Authorized Official - First Name:ALYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTINIANO-FRANZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-860-7962
Mailing Address - Street 1:26 QUEEN STREET
Mailing Address - Street 2:CREDENTIALING-MEDICAL SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7962
Mailing Address - Fax:508-860-7929
Practice Address - Street 1:420 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3802
Practice Address - Country:US
Practice Address - Phone:508-796-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CENTER OF WORCESTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-02
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4669261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020639BMedicaid