Healthcare Provider Details

I. General information

NPI: 1295149664
Provider Name (Legal Business Name): WPI HEALTH & WELLNESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INSTITUTE RD
WORCESTER MA
01609-2280
US

IV. Provider business mailing address

100 INSTITUTE RD
WORCESTER MA
01609-2280
US

V. Phone/Fax

Practice location:
  • Phone: 508-831-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number154005
License Number StateMA

VIII. Authorized Official

Name: MRS. REGINA A ROBERTO
Title or Position: DIRECTOR
Credential: NP
Phone: 508-831-5520