Provider Demographics
NPI:1386001105
Name:KENNEDY DONOVAN CENTER
Entity type:Organization
Organization Name:KENNEDY DONOVAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:508-772-1230
Mailing Address - Street 1:1 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2530
Mailing Address - Country:US
Mailing Address - Phone:508-772-1230
Mailing Address - Fax:508-203-8714
Practice Address - Street 1:486 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1386
Practice Address - Country:US
Practice Address - Phone:508-765-0292
Practice Address - Fax:508-765-0294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEDY DONOVAN CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAR32101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty