Healthcare Provider Details

I. General information

NPI: 1023930088
Provider Name (Legal Business Name): CHANCECOMMUNITYCARERI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PERKINS AVE
CRANSTON RI
02910-3912
US

IV. Provider business mailing address

40 PERKINS AVE
CRANSTON RI
02910-3912
US

V. Phone/Fax

Practice location:
  • Phone: 401-255-9869
  • Fax:
Mailing address:
  • Phone: 401-255-9869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICARDO PIERRE
Title or Position: CEO
Credential: CHW, CPRS
Phone: 401-255-9869