Healthcare Provider Details

I. General information

NPI: 1053128785
Provider Name (Legal Business Name): REFUGEE DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROAD ST
PROVIDENCE RI
02907-1601
US

IV. Provider business mailing address

747 BROAD ST
PROVIDENCE RI
02907-1601
US

V. Phone/Fax

Practice location:
  • Phone: 401-300-0544
  • Fax:
Mailing address:
  • Phone: 401-300-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TEDDI JALLOW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-300-0544