Healthcare Provider Details

I. General information

NPI: 1811020431
Provider Name (Legal Business Name): RI DEPT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CAPITOL HL ATTN M DOMENECH ROOM 209
PROVIDENCE RI
02908-5034
US

IV. Provider business mailing address

3 CAPITOL HILL ATTN M DOMENECH ROOM 209
PROVIDENCE RI
02908-5097
US

V. Phone/Fax

Practice location:
  • Phone: 401-222-7772
  • Fax: 401-222-6953
Mailing address:
  • Phone: 401-222-7772
  • Fax: 401-222-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH MARISI
Title or Position: KEY ADMINISTRATOR
Credential:
Phone: 401-222-1402