MEDICARE: KENNEDY DONOVAN CENTER, INC

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	251C00000X	Developmentally Disabled Services Day Training Agency

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	:	1568632040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY DONOVAN CENTER, INC

Provider Business Mailing Address
First Line	:	1 COMMERCIAL ST
Second Line	:
City	:	FOXBORO
State	:	MA
Zip	:	02035-2530
Country	:	US
Telephone Number	:	508-543-2542
Fax Number	:	508-543-9488

Provider Business Practice Location Address
First Line	:	19 HAWTHORN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-4938
Country	:	US
Telephone Number	:	508-992-4756
Fax Number	:	508-999-5367

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. KEVIN RODMAN CONARE
Credential	:
Telephone Number	:	508-543-2542

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	03/05/2012

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