Healthcare Provider Details

I. General information

NPI: 1881432094
Provider Name (Legal Business Name): CARENOVUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MONTICELLO ST APT 2
PROVIDENCE RI
02904-7832
US

IV. Provider business mailing address

14 MONTICELLO ST APT 2
PROVIDENCE RI
02904-7832
US

V. Phone/Fax

Practice location:
  • Phone: 617-704-0882
  • Fax:
Mailing address:
  • Phone: 617-704-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADEBAYO ADEDOKUN
Title or Position: OWNER
Credential:
Phone: 617-704-0882