=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013234822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORCESTER ADULT DAY CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2010
-----------------------------------------------------
Last Update Date | 02/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 LAFAYETTE ST # 3&4
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01608-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-831-7500
-----------------------------------------------------
Fax | 508-459-8501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 LAFAYETTE ST UNIT 3
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01608-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-831-7500
-----------------------------------------------------
Fax | 508-459-8501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YEVGENY ZELTSER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-831-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------