Healthcare Provider Details

I. General information

NPI: 1558768663
Provider Name (Legal Business Name): EAST PROVIDENCE SENIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WATERMAN AVE
EAST PROVIDENCE RI
02914-2427
US

IV. Provider business mailing address

610 WATERMAN AVE
EAST PROVIDENCE RI
02914-2427
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-7800
  • Fax: 401-435-7803
Mailing address:
  • Phone: 401-435-7800
  • Fax: 401-435-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ROCK
Title or Position: DIRECTOR
Credential:
Phone: 401-435-7800