Healthcare Provider Details

I. General information

NPI: 1972662104
Provider Name (Legal Business Name): CHILDREN'S FRIEND AND SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 SUMMER ST
PROVIDENCE RI
02903-4011
US

IV. Provider business mailing address

153 SUMMER ST
PROVIDENCE RI
02903-4011
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4300
  • Fax: 401-331-3285
Mailing address:
  • Phone: 401-276-4300
  • Fax: 401-331-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RON CONTRERAS
Title or Position: CONTROLLER
Credential:
Phone: 401-276-4300