# DODGE PARK AT HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487927778
- **Authorized official:** MR. MICHA SHALEV (MANAGER/MEMBER)
- **Authorized official phone:** (508) 853-8180

## 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 |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 8110 | MA | Yes |

## Other

- **Enumeration date:** 02/16/2012
- **Last updated:** 02/16/2012