Healthcare Provider Details

I. General information

NPI: 1982699666
Provider Name (Legal Business Name): ANNA MARIA REST HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 MAIN ST
WORCESTER MA
01603-1524
US

IV. Provider business mailing address

1398 MAIN ST
WORCESTER MA
01603-1524
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-1515
  • Fax: 508-831-7938
Mailing address:
  • Phone: 508-756-1515
  • Fax: 508-831-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: JENA KUZDZAL
Title or Position: BOOKKEEPER
Credential:
Phone: 508-949-7455