Healthcare Provider Details

I. General information

NPI: 1104654789
Provider Name (Legal Business Name): ALTERNATIVE WELLNESS CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W BOYLSTON DR STE 202
WORCESTER MA
01606-2799
US

IV. Provider business mailing address

146 W BOYLSTON DR STE 202
WORCESTER MA
01606-2799
US

V. Phone/Fax

Practice location:
  • Phone: 508-212-9364
  • Fax:
Mailing address:
  • Phone: 508-212-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN MCKINNON
Title or Position: PRESIDENT
Credential:
Phone: 508-212-9364