Healthcare Provider Details

I. General information

NPI: 1093848327
Provider Name (Legal Business Name): SSTAR OF RHODE ISLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 TOWER HILL RD
NORTH KINGSTOWN RI
02852-6628
US

IV. Provider business mailing address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-6160
  • Fax: 401-295-2513
Mailing address:
  • Phone: 508-235-7010
  • Fax: 508-646-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number616
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number616.1
License Number StateRI

VIII. Authorized Official

Name: FRANK SPICOLA
Title or Position: DIRECTOR
Credential: LCDP
Phone: 401-294-6160