Healthcare Provider Details

I. General information

NPI: 1730697343
Provider Name (Legal Business Name): GOLDEN ROADS ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 INDUSTRIAL CIR
LINCOLN RI
02865-2645
US

IV. Provider business mailing address

25 DUXBURY ST
PROVIDENCE RI
02909-6001
US

V. Phone/Fax

Practice location:
  • Phone: 401-340-9323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EFRAIN GRECO
Title or Position: OWNER
Credential:
Phone: 401-340-9323