Provider Demographics
NPI:1154600344
Name:EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Entity type:Organization
Organization Name:EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-854-2122
Mailing Address - Street 1:115 NE CUTOFF STE 200
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1224
Mailing Address - Country:US
Mailing Address - Phone:508-854-2122
Mailing Address - Fax:508-853-8593
Practice Address - Street 1:354 WAVERLY ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7079
Practice Address - Country:US
Practice Address - Phone:508-370-0113
Practice Address - Fax:508-370-3637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-05
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110022061EMedicaid
MA110022061EMedicaid