Healthcare Provider Details

I. General information

NPI: 1841323094
Provider Name (Legal Business Name): SSTAR OF RHODE ISLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EAST ST
CRANSTON RI
02920-4421
US

IV. Provider business mailing address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

V. Phone/Fax

Practice location:
  • Phone: 401-463-6001
  • Fax: 401-463-8572
Mailing address:
  • Phone: 508-235-7010
  • Fax: 508-646-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number617.1
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number617
License Number StateRI

VIII. Authorized Official

Name: MRS. DIANE GOUVEIA
Title or Position: PROGRAM DIRECTOR
Credential: LICSW
Phone: 401-463-6001