Healthcare Provider Details

I. General information

NPI: 1508514910
Provider Name (Legal Business Name): ST. MARY'S HOME FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FRUIT HILL AVE
NORTH PROVIDENCE RI
02911-2647
US

IV. Provider business mailing address

420 FRUIT HILL AVE
NORTH PROVIDENCE RI
02911-2647
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-3900
  • Fax:
Mailing address:
  • Phone: 401-353-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CARLENE CASCIANO-MCCANN
Title or Position: EXECUTIVE DIRECTOR
Credential: LMHC
Phone: 401-353-3900