Healthcare Provider Details

I. General information

NPI: 1417947383
Provider Name (Legal Business Name): WOOD RIVER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MAIN STREET
HOPE VALLEY RI
02832-1920
US

IV. Provider business mailing address

823 MAIN STREET
HOPE VALLEY RI
02832-1920
US

V. Phone/Fax

Practice location:
  • Phone: 401-539-2461
  • Fax: 401-539-2663
Mailing address:
  • Phone: 401-539-2461
  • Fax: 401-539-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number2213
License Number StateRI
# 7
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateRI

VIII. Authorized Official

Name: TRACY L PION
Title or Position: DIRECTOR OF FINANCIAL OPERATIONS
Credential:
Phone: 401-539-2461