Healthcare Provider Details

I. General information

NPI: 1114838604
Provider Name (Legal Business Name): CARPENTER HALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 PAWTUCKET AVE
PAWTUCKET RI
02860-3811
US

IV. Provider business mailing address

251 MAIN ST
EXETER RI
02822-3531
US

V. Phone/Fax

Practice location:
  • Phone: 877-262-7803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTI PROVUNCHER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-295-0960