Healthcare Provider Details

I. General information

NPI: 1538022793
Provider Name (Legal Business Name): SALT OF THE EARTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BYRON ST
NORTH PROVIDENCE RI
02911-1922
US

IV. Provider business mailing address

30 BYRON ST
NORTH PROVIDENCE RI
02911-1922
US

V. Phone/Fax

Practice location:
  • Phone: 401-601-5476
  • Fax:
Mailing address:
  • Phone: 401-601-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN RICCO
Title or Position: OWNER
Credential: LADC1
Phone: 401-601-5476