Healthcare Provider Details

I. General information

NPI: 1568771004
Provider Name (Legal Business Name): ELDER SERVICES OF WORCESTER AREA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CHANDLER ST
WORCESTER MA
01602-3339
US

IV. Provider business mailing address

411 CHANDLER ST
WORCESTER MA
01602-3339
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-1545
  • Fax: 508-754-7771
Mailing address:
  • Phone: 508-756-1545
  • Fax: 508-754-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1908863
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MRS. MARY BALTRAMAITIS
Title or Position: FISCAL MANAGER
Credential:
Phone: 508-756-1545