Provider Demographics
NPI:1912486622
Name:ALORIA HEALTH OF WORCESTER, LLC
Entity Type:Organization
Organization Name:ALORIA HEALTH OF WORCESTER, LLC
Other - Org Name:WASHBURN HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EDI/CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-567-7256
Mailing Address - Street 1:PO BOX 207977
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7977
Mailing Address - Country:US
Mailing Address - Phone:201-470-5749
Mailing Address - Fax:
Practice Address - Street 1:1183 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2012
Practice Address - Country:US
Practice Address - Phone:201-470-5749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========Medicaid