Healthcare Provider Details

I. General information

NPI: 1225549298
Provider Name (Legal Business Name): CARE CENTER RHODE ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WARREN AVE
EAST PROVIDENCE RI
02914
US

IV. Provider business mailing address

400 WARREN AVE
EAST PROVIDENCE RI
02914-3826
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-9024
  • Fax: 401-431-9027
Mailing address:
  • Phone: 401-431-9024
  • Fax: 401-431-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberRI06534
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberRI06534
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberRI06534
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberRI06534
License Number StateRI

VIII. Authorized Official

Name: LISA ROSSI
Title or Position: OFFICE MANAGER
Credential:
Phone: 401-431-9024