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NPI Code Detail

MEDICARE: THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.

MEDICARE: THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1669474102
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.
Provider Business Mailing Address
First Line : 375 ALLENS AVE
Second Line :
City : PROVIDENCE
State : RI
Zip : 02905-5010
Country : US
Telephone Number : 401-444-0400
Fax Number : 401-444-0468
Provider Business Practice Location Address
First Line : 40 CANDACE ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02908-3747
Country : US
Telephone Number : 401-444-0550
Fax Number : 401-444-0425
Authorized Official
Title or Position : CFO
Name : MR. KEVIN CABRAL
Credential :
Telephone Number : 401-444-0400
Provider Enumeration Date : 08/15/2005
Last Update Date : 12/05/2024

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1750360236 — BETH A. TOOLAN MD
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1780663286 — DILEK CERMIK MD
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Directions to “THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC. ” Practice Location

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