Healthcare Provider Details

I. General information

NPI: 1821472135
Provider Name (Legal Business Name): CHARTER CARE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 PUTNAM PIKE UNIT # 15
GREENVILLE RI
02828-3000
US

IV. Provider business mailing address

466 PUTNAM PIKE UNIT # 15
GREENVILLE RI
02828-3000
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-2010
  • Fax:
Mailing address:
  • Phone: 401-949-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00704
License Number StateRI

VIII. Authorized Official

Name: ROBERT JON ELDERS
Title or Position: SECRETARY
Credential:
Phone: 714-788-1249