Healthcare Provider Details

I. General information

NPI: 1073162202
Provider Name (Legal Business Name): JEWISH COLLABORATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N MAIN ST
PROVIDENCE RI
02904-5740
US

IV. Provider business mailing address

1165 N MAIN ST
PROVIDENCE RI
02904-5740
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-1244
  • Fax:
Mailing address:
  • Phone: 401-331-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MERELISE A HITTE
Title or Position: CFO
Credential:
Phone: 401-331-1244