Healthcare Provider Details

I. General information

NPI: 1811496664
Provider Name (Legal Business Name): DIVERSITY ADULT DAY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 ELMWOOD AVE
PROVIDENCE RI
02907-1766
US

IV. Provider business mailing address

433 ELMWOOD AVE
PROVIDENCE RI
02907-1766
US

V. Phone/Fax

Practice location:
  • Phone: 401-427-1337
  • Fax: 401-369-7818
Mailing address:
  • Phone: 401-427-1337
  • Fax: 401-369-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC00048
License Number StateRI

VIII. Authorized Official

Name: MR. COLIN P HANRAHAN
Title or Position: CEO
Credential:
Phone: 401-427-1337