Healthcare Provider Details

I. General information

NPI: 1932478146
Provider Name (Legal Business Name): NORTHWEST COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ROCK AVE
PASCOAG RI
02859-0152
US

IV. Provider business mailing address

PO BOX 312
PASCOAG RI
02859-0312
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-2549
  • Fax: 401-568-6085
Mailing address:
  • Phone: 401-567-0800
  • Fax: 401-567-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER J BANCROFT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 401-285-5119