Healthcare Provider Details

I. General information

NPI: 1235126335
Provider Name (Legal Business Name): CENTRAL MASS HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MAIN ST
WORCESTER MA
01603-1550
US

IV. Provider business mailing address

1350 MAIN ST
WORCESTER MA
01603-1550
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-4200
  • Fax: 508-791-0269
Mailing address:
  • Phone: 508-791-4200
  • Fax: 508-791-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4150
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier0925926
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MR. RICHARD I KRAVETZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-791-4200