# DODGE PARK LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dodge Park Rest Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104017961
- **Authorized official:** MR. BEN HERLINGER (MEMBER/MANAGER)
- **Authorized official phone:** (818) 571-8972

## Contact information

- **Practice address:** 101 RANDOLPH RD, WORCESTER, MA 01606-2463
- **Practice address phone:** (508) 853-8180
- **Practice address fax:** (508) 853-4545
- **Mailing address:** 101 RANDOLPH RD, WORCESTER, MA 01606-2463
- **Mailing address phone:** (508) 853-8180
- **Mailing address fax:** (508) 853-4545

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 1318 | MA | Yes |

## Other

- **Enumeration date:** 08/07/2007
- **Last updated:** 08/07/2007