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General NPI Number Information
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NPI Number | 1649344821
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Entity Type | Organization
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Legal Business Name | HENRY LEE WILLIS COMMUNITY CENTER, INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 44 FRONT ST SUITE 480
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City | WORCESTER
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State | MA
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Zip | 01608-1733
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Country | US
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Telephone | 508-799-2934
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Fax | 508-770-1732
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Provider Business Mailing Address
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Address Line | 119 FOREST ST
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City | WORCESTER
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State | MA
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Zip | 01609-1529
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Country | US
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Telephone | 508-799-0702
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Fax | 508-754-0245
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARLTON A WATSON
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Credential |
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Telephone | 508-799-0702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0690
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License Number State | MA
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