Healthcare Provider Details

I. General information

NPI: 1124774062
Provider Name (Legal Business Name): CENTRAL FALLS CHILDREN'S FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 BROAD STREET.
CENTRAL FALLS RI
02863-2837
US

IV. Provider business mailing address

577 BROAD STREET.
CENTRAL FALLS RI
02863-2837
US

V. Phone/Fax

Practice location:
  • Phone: 401-305-1950
  • Fax: 401-543-2112
Mailing address:
  • Phone: 401-339-7046
  • Fax: 401-543-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BEATA FELICIA NELKEN
Title or Position: DIRECTOR
Credential: MD
Phone: 401-339-7046