Healthcare Provider Details

I. General information

NPI: 1275514093
Provider Name (Legal Business Name): RJ HOLDING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 BROAD ST
CRANSTON RI
02905
US

IV. Provider business mailing address

1725 BROAD STREET
CRANSTON RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-467-9111
  • Fax: 401-461-1390
Mailing address:
  • Phone: 401-467-9111
  • Fax: 401-461-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number1001
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1001
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number1001
License Number StateRI

VIII. Authorized Official

Name: JOHN DIORIO JR.
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: M.D.
Phone: 401-467-9111