Provider Demographics
NPI:1912203217
Name:GODDARD/HOMESTEAD
Entity Type:Organization
Organization Name:GODDARD/HOMESTEAD
Other - Org Name:HOMESTEAD HALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-753-4890
Mailing Address - Street 1:1199 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603
Mailing Address - Country:US
Mailing Address - Phone:508-753-4890
Mailing Address - Fax:508-797-1400
Practice Address - Street 1:10 HOMESTEAD AVENUE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-755-7915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility