Healthcare Provider Details

I. General information

NPI: 1659845451
Provider Name (Legal Business Name): COMPREHENSIVE COMMUNITY ACTION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOWARD AVE
CRANSTON RI
02920-3031
US

IV. Provider business mailing address

311 DORIC AVE
CRANSTON RI
02910-2903
US

V. Phone/Fax

Practice location:
  • Phone: 401-467-9610
  • Fax:
Mailing address:
  • Phone: 401-562-8305
  • Fax: 401-467-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JUSTINE SANDS
Title or Position: CFO
Credential:
Phone: 401-562-2249