Healthcare Provider Details

I. General information

NPI: 1437096518
Provider Name (Legal Business Name): CAMP ITALIA RETREAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BAY EDGE LN
WORCESTER MA
01604-1303
US

IV. Provider business mailing address

10 BAY EDGE LN
WORCESTER MA
01604-1303
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-9002
  • Fax:
Mailing address:
  • Phone: 508-753-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: RAYMUND LOPOLITO
Title or Position: DIRECTOR
Credential:
Phone: 508-753-9002