Dodge Park Rest Home Inc.

Primary specialty

Corporate Health Clinic/CenterTaxonomy code 261QC1800X

License

87511 Issued in MA

Legal business name

DODGE PARK REST HOME INC.

Practice address

101 Randolph Rd
Worcester, MA 01606-2463

Phone

(508) 853-8180

NPI assigned

Feb 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anthony E. Penny

Title

Administrator

Phone

(508) 853-8180

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154464584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 RANDOLPH RD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 RANDOLPH RD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062463",
            "telephone_number": "508-853-8180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DODGE PARK REST HOME INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PENNY",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "508-853-8180"
    },
    "taxonomies": [
        {
            "code": "261QC1800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Corporate Health",
            "state": "MA",
            "license": "87511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER #",
            "identifier": "5500079",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Dobles, MD
• Michelina Libera Docimo, M.S.
• Dominique Matica Dockery, MD
• Dodge Park at Home
• Dodge Park LLC
• Linda L Dodge, N.P.
• Robyn Dodge
• Hannah Dodier
• Kasia S Dodman, NP
• Florence J Doe, DOULA

• Corporate Health Clinic/Center in Worcester, MA
• Providers in Worcester, MA by specialty
• Corporate Health Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.