Organization
EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Active
Parent organization
EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Other names
Great Brook Valley Health Center, Inc
Organization subpart
Yes
Provider details
NPI number
Legal business name
EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Authorized official
MR. STEPHEN J. KERRIGAN (PRESIDENT & CEO)
(508) 854-2122
Entity
Organization
Contact information
Practice address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
(508) 854-3248
Mailing address
115 NE CUTOFF STE 200, WORCESTER, MA 01606-1224
(508) 854-2122
(508) 853-8593
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
4039
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0443891
—
MA
05
—
110022061B
—
MA
05
—
1301071
—
MA
05
—
1320858
—
MA
01
—
Y10100
BCBS OF MA
MA
Enumeration date
02/24/2006
Last updated
01/31/2023
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