Provider Demographics
NPI:1801181334
Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Other - Org Name:SULLIVAN MIDDLE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR. PROVIDER RELATIONS
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 1:140 APRICOT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1225
Mailing Address - Country:US
Mailing Address - Phone:508-757-5350
Mailing Address - Fax:508-755-6832
Practice Address - Street 1:140 APRICOT ST
Practice Address - Street 2:SULLIVAN MIDDLE HEALTH CENTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1225
Practice Address - Country:US
Practice Address - Phone:508-757-5350
Practice Address - Fax:508-755-6832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CENTER OF WORCESTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-13
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4669261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)