Healthcare Provider Details

I. General information

NPI: 1497984363
Provider Name (Legal Business Name): EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 UNION AVE
FRAMINGHAM MA
01702-8216
US

IV. Provider business mailing address

115 NE CUTOFF STE 200
WORCESTER MA
01606-1224
US

V. Phone/Fax

Practice location:
  • Phone: 508-270-5700
  • Fax: 508-370-3637
Mailing address:
  • Phone: 508-854-2122
  • Fax: 508-853-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number4039
License Number StateMA

VIII. Authorized Official

Name: MR. STEPHEN J KERRIGAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 508-854-2122