Healthcare Provider Details

I. General information

NPI: 1255872529
Provider Name (Legal Business Name): AMOS HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 PINE ST
PROVIDENCE RI
02907-1358
US

IV. Provider business mailing address

460 PINE ST
PROVIDENCE RI
02907-1358
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-9372
  • Fax:
Mailing address:
  • Phone: 401-274-9372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MS. EILEEN MARY HAYES
Title or Position: CEO
Credential: LICSW
Phone: 401-274-9372