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General NPI Number Information
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NPI Number | 1285236356
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Entity Type | Organization
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Legal Business Name | WORCESTER AFC, LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 35 HARRINGTON AVE UNIT 4308
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City | SHREWSBURY
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State | MA
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Zip | 01545-5286
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Country | US
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Telephone | 718-916-6721
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Fax |
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Provider Business Mailing Address
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Address Line | 35 HARRINGTON AVE UNIT 4308
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City | SHREWSBURY
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State | MA
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Zip | 01545-5286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEONID KOMSKY
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Credential |
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Telephone | 718-916-6721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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