Healthcare Provider Details

I. General information

NPI: 1891048393
Provider Name (Legal Business Name): URBAN LEAGUE OF RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PRAIRIE AVE
PROVIDENCE RI
02905-2333
US

IV. Provider business mailing address

246 PRAIRIE AVE
PROVIDENCE RI
02905-2333
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-5000
  • Fax: 401-454-1946
Mailing address:
  • Phone: 401-351-5000
  • Fax: 401-454-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number64272
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number57062
License Number StateRI

VIII. Authorized Official

Name: DENNIS BARRINGTON LANGLEY
Title or Position: CEO
Credential: PH.L
Phone: 401-351-5000