Healthcare Provider Details

I. General information

NPI: 1720415219
Provider Name (Legal Business Name): MASSACHUSETTS CENTER FOR PEOPLE, WORK & LEARNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 JUNE ST
WORCESTER MA
01602
US

IV. Provider business mailing address

259 JUNE STREET
WORCESTER MA
01602
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-2733
  • Fax:
Mailing address:
  • Phone: 508-363-2733
  • Fax: 508-755-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ANITA C WASIRI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 508-363-2733