Healthcare Provider Details

I. General information

NPI: 1457302002
Provider Name (Legal Business Name): ENCOMPASS CARE COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL STE 301
LINCOLN RI
02865-1112
US

IV. Provider business mailing address

6 BLACKSTONE VALLEY PL STE 301
LINCOLN RI
02865-1112
US

V. Phone/Fax

Practice location:
  • Phone: 508-769-2707
  • Fax: 401-305-3028
Mailing address:
  • Phone: 508-769-2707
  • Fax: 401-305-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: BORIS O. BERGUS
Title or Position: CEO
Credential: MD
Phone: 508-769-2707