MEDICARE: CENTRAL MASS HEALTH SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	4150	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235126335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MASS HEALTH SYSTEMS

Provider Business Mailing Address
First Line	:	1350 MAIN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01603-1550
Country	:	US
Telephone Number	:	508-791-4200
Fax Number	:	508-791-0269

Provider Business Practice Location Address
First Line	:	1350 MAIN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01603-1550
Country	:	US
Telephone Number	:	508-791-4200
Fax Number	:	508-791-0269

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RICHARD I KRAVETZ
Credential	:
Telephone Number	:	508-791-4200

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/22/2020

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