DODGE PARK REST HOME INC. NPI 1154464584

NPI Information

NPI: 1154464584
Provider Name: DODGE PARK REST HOME INC.
Classification: Clinic/Center - 261QC1800X
Entity Type: Organization

Specialization: Corporate Health

CLIA Number: 22D2112381

Address:
101 RANDOLPH RD
WORCESTER, MA
ZIP 01606
Phone: (508) 853-8180
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DODGE PARK REST HOME INC. is a corporate health clinic center in Worcester, MA. DODGE PARK REST HOME INC. NPI is 1154464584. The provider is registered as an organization entity type.

The provider's business location address is:

101 RANDOLPH RD
WORCESTER, MA
ZIP 01606-463
Phone: (508) 853-8180

The provider's authorized official is Anthony E. Penny .
The authorized official title is Administrator and has the following contact phone number (508) 853-8180.

The CLIA number assigned to this NPI record is 22D2112381 - other - rest home with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/15/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QC1800X	Clinic/Center	Corporate Health	87511	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5500079	OTHER	MASSACHUSETTS	PROVIDER #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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