Healthcare Provider Details

I. General information

NPI: 1801951397
Provider Name (Legal Business Name): NORTHWEST COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CALLAHAN RD
N. KINGSTOWN RI
02852-7739
US

IV. Provider business mailing address

PO BOX 312
PASCOAG RI
02859
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-9706
  • Fax: 401-295-0920
Mailing address:
  • Phone: 401-568-7664
  • Fax: 401-285-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberACF01530
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberACF01597
License Number StateRI

VIII. Authorized Official

Name: MR. PETER J. BANCROFT
Title or Position: PRESIDENT & CEO
Credential: CPA
Phone: 401-285-5119