Healthcare Provider Details

I. General information

NPI: 1306566492
Provider Name (Legal Business Name): LAZO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GEORGE WATERMAN RD
JOHNSTON RI
02919-2666
US

IV. Provider business mailing address

5 GEORGE WATERMAN RD
JOHNSTON RI
02919-2666
US

V. Phone/Fax

Practice location:
  • Phone: 401-233-0314
  • Fax:
Mailing address:
  • Phone: 401-233-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMES WILLIAMS
Title or Position: MANAGER
Credential:
Phone: 401-439-5534