Healthcare Provider Details

I. General information

NPI: 1114138773
Provider Name (Legal Business Name): EAST BAY COMMUNTIY ACTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BROADWAY
NEWPORT RI
02840-2937
US

IV. Provider business mailing address

19 BROADWAY
NEWPORT RI
02840-2937
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-6697
  • Fax: 401-841-0264
Mailing address:
  • Phone: 401-848-6697
  • Fax: 401-841-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RILWAN FEYISITAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 401-848-6697