Healthcare Provider Details

I. General information

NPI: 1053447433
Provider Name (Legal Business Name): FAMILY SERVICE OF RHODE ISLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 CHALKSTONE AVE
PROVIDENCE RI
02908-3904
US

IV. Provider business mailing address

55 HOPE ST
PROVIDENCE RI
02906-2001
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-1350
  • Fax: 401-277-3378
Mailing address:
  • Phone: 401-331-1350
  • Fax: 401-277-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateRI

VIII. Authorized Official

Name: MR. MICHAEL W GAVRITY
Title or Position: CFO
Credential:
Phone: 401-331-1350