Healthcare Provider Details

I. General information

NPI: 1669428348
Provider Name (Legal Business Name): EAST BAY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OLD COUNTY RD
BARRINGTON RI
02806-1602
US

IV. Provider business mailing address

2 OLD COUNTY RD
BARRINGTON RI
02806-1602
US

V. Phone/Fax

Practice location:
  • Phone: 401-437-8844
  • Fax: 401-437-8847
Mailing address:
  • Phone: 401-437-8844
  • Fax: 401-437-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number623
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number623
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number623
License Number StateRI

VIII. Authorized Official

Name: MR. ROBERT A. CROSSLEY
Title or Position: CHIEF EXECUTIVE OFFICERF
Credential:
Phone: 401-437-8844