EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC (NPI# 1013048347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013048347 |
| Entity Type | Organization |
| Organization Name | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC |
| Other Organization Name | GREAT BROOK VALLEY HEALTH CENTER, INC |
| Practice Address |
19 Tacoma St Worcester MA 01605-3516 |
| Mailing Address |
650 Lincoln St Worcester MA 01605-2060 |
| Practice Telephone | 5088542128 |
| Practice Fax Number | 5085951127 |
| Mailing Telephone | 5088542122 |
| Mailing Fax Number | 5088538593 |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-11-27 |
| Authorized Official Name | MR. STEPHEN J KERRIGAN (PRESIDENT & CEO) |
| Authorized Official Telephone | 5088542122 |
| Is Organization Subpart | Y |
| Parent Organization Name | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
495 | MA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 0443891 | 05 | |
| MA | 110022061A | 05 |
| Other Name | Type Code |
|---|---|
| Great Brook Valley Health Center, Inc | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568828622 | Edward M. Kennedy Community Health Center, Inc | Registered Nurse | 354 Waverly St, Framingham, MA 01702-7079 | 2016-01-05 |
| 1316324650 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 631 Lincoln St, Worcester, MA 01605-2010 | 2015-05-06 |
| 1992137426 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 42 Cape Rd, Milford, MA 01757-3292 | 2013-08-07 |
| 1700152758 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 585 Lincoln St, Worcester, MA 01605-1906 | 2012-03-23 |
| 1154600344 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 354 Waverly St, Framingham, MA 01702-7079 | 2011-08-05 |
| 1497984363 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 72 Union Ave, Framingham, MA 01702-8216 | 2009-07-13 |
| 1609842152 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 19 Tacoma St, Worcester, MA 01605-3516 | 2006-02-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC. | 650 Lincoln St Ste 1, Worcester, MA 01605-2060 |
| Street Address |
19 TACOMA ST |
| City | WORCESTER |
| State | MA |
| Zip Code | 01605-3516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114902038 | Gina E. D'ottavio | Family Medicine | 19 Tacoma St, Worcester, MA 01605-3516 | 2005-12-14 |
| 1952909319 | Michelle Elicier | Licensed Practical Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-10-16 |
| 1396342275 | Christine Anne Tuohy | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-10-05 |
| 1437756335 | Madeline Fennon Lane | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-10-04 |
| 1962016584 | Julie Fraher | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-09-01 |
| 1598377699 | Victor O Boadu | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-08-19 |
| 1053922963 | Shanoska Vasquez Garcia | Counselor | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-08-13 |
| 1588289300 | Jeffrey P Chhim | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-06-09 |
| 1629692470 | Diana Portillo | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-06-07 |
| 1467076810 | Stacie Robbins | Pharmacist | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-06-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083228340 | Francisca A Bediako | Registered Nurse | Commonwealth Care Alliance, 100 North Parkway-suite # 202, Worcester, MA 01605 | 2020-09-03 |
| 1922660646 | Jenna Patricia Mullarkey | Counselor | Ummmc, Hahnemann Family Health Center, 279 Lincoln Street, Worcester, MA 01605 | 2019-07-02 |
| 1295219293 | Valerie Ann Wedge | Social Worker | 382 Plantation Street, Worcester, MA 01605 | 2018-09-17 |
| 1154800290 | Keri Innis-grant | Counselor | 108 Grove Street, Ste Ll11, Worcester, MA 01605 | 2018-08-09 |
| 1184119463 | Madiinah Namutebi | Registered Nurse | 56 Olga Ave, Worcester, MA 01605 | 2018-06-28 |
| 1841789310 | Ashley Murray | Psychologist | 361 Plantation St., Attn: Forensic Services, Worcester, MA 01605 | 2018-05-09 |
| 1184126419 | Nadia Saforo | Nurse Practitioner | 509 Plantation St Apt 221, Worcester, MA 01605 | 2018-03-02 |
| 1548779044 | Arnold Kamau Thuku | Behavioral Analyst | 55 Erie Ave, Worcester, MA 01605 | 2017-09-27 |
| 1417466483 | Sabine Erica Charles-arbouet | Registered Nurse | 25 Oriol Drive, Worcester, MA 01605 | 2017-09-21 |
| 1548787864 | Alyssa Lynn Champagne | Behavioral Analyst | 19 Judson Rd, Worcester, MA 01605 | 2017-08-28 |
| Find all providers in zip 01605 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1053776211 | The Hospital Corporation | Pharmacy | 55 Fruit St # Gb005, Ma General Hosptital, Boston, MA 02114-2621 | 2015-12-15 |
| 1487806725 | East Boston Neighborhood Health Center, Inc | Pharmacy | 26 Sturgis St, Winthrop, MA 02152-1219 | 2008-10-17 |
| 1235292863 | Ppf Inc | Pharmacy | 499 Eastern Ave, Lynn, MA 01902-1570 | 2006-12-18 |
| 1326155458 | The Commonwealth of Massachusetts | Pharmacy | 165 Quincy St, Brockton, MA 02302-2988 | 2006-08-24 |
| 1689144982 | Brigham & Womens Hospital, Inc. | Pharmacy | 45 Francis St, Boston, MA 02115-6105 | 2018-11-29 |
| 1144743410 | Community Health Center of Cape Cod, Inc. | Pharmacy | 123 Waterhouse Rd, Bourne, MA 02532-3890 | 2017-07-19 |
| 1164860540 | Atrius Health Inc. Dba Harvard Vanguard Medical Associates | Pharmacy | 330 Baker Ave, Concord, MA 01742-2188 | 2013-06-07 |
| 1497198303 | Steward St. Anne's Hospital Corp. Reginal Cancer Center | Pharmacy | 537 Faunce Corner Rd, North Dartmouth, MA 02747-1242 | 2013-04-10 |
| 1295068559 | Charles River Community Health, Inc | Pharmacy | 495 Western Ave, Brighton, MA 02135-1007 | 2009-09-17 |
| 1487894291 | Cvs Pharmacy, Inc. | Pharmacy | 55 Dimock St, Roxbury, MA 02119-1029 | 2009-03-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.