Healthcare Provider Details

I. General information

NPI: 1205383767
Provider Name (Legal Business Name): THE PARKINSON'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BLACKSTONE AVE
PAWTUCKET RI
02860-1068
US

IV. Provider business mailing address

65 BLACKSTONE AVENUE
PAWTUCKET RI
02860-1001
US

V. Phone/Fax

Practice location:
  • Phone: 401-728-2039
  • Fax:
Mailing address:
  • Phone: 401-728-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD GINGRAS
Title or Position: PROPRIETOR
Credential:
Phone: 508-316-6520