Healthcare Provider Details

I. General information

NPI: 1295494227
Provider Name (Legal Business Name): CARPENTER HALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6946 POST RD STE 300
NORTH KINGSTOWN RI
02852-7613
US

IV. Provider business mailing address

251 MAIN ST
EXETER RI
02822-3531
US

V. Phone/Fax

Practice location:
  • Phone: 877-262-7803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GILBERT YATES
Title or Position: CONTRACT MANAGER
Credential:
Phone: 877-262-7803