Healthcare Provider Details

I. General information

NPI: 1992021653
Provider Name (Legal Business Name): INTERNATIONAL INSTITUTE OF RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 ELMWOOD AVE
PROVIDENCE RI
02907-3313
US

IV. Provider business mailing address

645 ELMWOOD AVE
PROVIDENCE RI
02907-3313
US

V. Phone/Fax

Practice location:
  • Phone: 401-784-8647
  • Fax:
Mailing address:
  • Phone: 401-784-8647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DALE HALBURIAN
Title or Position: FISCAL DIRECTOR
Credential:
Phone: 401-784-8647