Healthcare Provider Details

I. General information

NPI: 1609164144
Provider Name (Legal Business Name): THE FOGARTY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAPLE AVENUE SUITE 102
BARRINGTON RI
02806
US

IV. Provider business mailing address

310 MAPLE AVENUE SUITE 102
BARRINGTON RI
02806
US

V. Phone/Fax

Practice location:
  • Phone: 401-245-7900
  • Fax: 401-245-7910
Mailing address:
  • Phone: 401-245-7900
  • Fax: 401-245-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number91
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number42
License Number StateRI

VIII. Authorized Official

Name: MR. DAVID C REISS
Title or Position: CEO
Credential:
Phone: 401-245-7900