MEDICARE: FORNDAWANTAB

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1841034857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORNDAWANTAB

Provider Business Mailing Address
First Line	:	61 MERRIFIELD ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-2924
Country	:	US
Telephone Number	:	346-232-0150
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 MERRIFIELD ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-2924
Country	:	US
Telephone Number	:	346-232-0150
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JULIUS NDASI
Credential	:
Telephone Number	:	346-232-0150

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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Directions to “FORNDAWANTAB ” Practice Location

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