Healthcare Provider Details

I. General information

NPI: 1053514935
Provider Name (Legal Business Name): TRI-TOWN ECONOMIC OPPORTUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 HARTFORD AVE
JOHNSTON RI
02919-7130
US

IV. Provider business mailing address

1126 HARTFORD AVE
JOHNSTON RI
02919-7130
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-2750
  • Fax: 401-351-6613
Mailing address:
  • Phone: 401-351-2750
  • Fax: 401-351-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number619
License Number StateRI

VIII. Authorized Official

Name: JOSEPH R DESANTIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-351-2750