Organization
DODGE PARK REST HOME INC.
Active
Organization
DODGE PARK REST HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY E. PENNY (ADMINISTRATOR)
(508) 853-8180
Entity
Organization
Contact information
Practice address
101 RANDOLPH RD, WORCESTER, MA 01606-2463
(508) 853-8180
Mailing address
101 RANDOLPH RD, WORCESTER, MA 01606-2463
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
Primary
87511
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5500079
PROVIDER #
MA
Enumeration date
02/15/2007
Last updated
08/22/2020
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