Healthcare Provider Details

I. General information

NPI: 1518185818
Provider Name (Legal Business Name): BAYSIDE FAMILY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CALLAHAN RD
NORTH KINGSTOWN RI
02852-7739
US

IV. Provider business mailing address

308 CALLAHAN RD
NORTH KINGSTOWN RI
02852-7739
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-9706
  • Fax: 401-295-0920
Mailing address:
  • Phone: 401-295-9706
  • Fax: 401-295-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberACF01503
License Number StateRI

VIII. Authorized Official

Name: MRS. CHARLOTTE TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential: RN,
Phone: 401-295-9706