Healthcare Provider Details

I. General information

NPI: 1477684181
Provider Name (Legal Business Name): CRANSTON ARC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BATCHELLER AVE
CRANSTON RI
02920-5128
US

IV. Provider business mailing address

111 COMSTOCK PKWY
CRANSTON RI
02921-2002
US

V. Phone/Fax

Practice location:
  • Phone: 401-941-1112
  • Fax: 401-941-2516
Mailing address:
  • Phone: 401-941-1112
  • Fax: 401-941-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number30
License Number StateRI

VIII. Authorized Official

Name: PAT COPPAGE
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 401-941-1112