Healthcare Provider Details

I. General information

NPI: 1679805741
Provider Name (Legal Business Name): TRI-TOWN ECONOMIC OPPORTUNITY COMMITTEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

IV. Provider business mailing address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-2750
  • Fax: 401-351-6611
Mailing address:
  • Phone: 401-351-2750
  • Fax: 401-351-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateRI

VIII. Authorized Official

Name: MR. JOSEPH R DESANTIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 401-351-2750