Healthcare Provider Details

I. General information

NPI: 1881735389
Provider Name (Legal Business Name): JUSTICE RESOURCE INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 DYER AVE
CRANSTON RI
02920-6714
US

IV. Provider business mailing address

160 GOULD ST SUITE 300
NEEDHAM MA
02494-2313
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-5694
  • Fax:
Mailing address:
  • Phone: 781-559-4900
  • Fax: 781-559-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number296
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANDY POND
Title or Position: PRESIDENT
Credential: LICSW
Phone: 781-559-4900