Healthcare Provider Details

I. General information

NPI: 1720014442
Provider Name (Legal Business Name): MEETING STREET CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDDY STREET
PROVIDENCE RI
02905
US

IV. Provider business mailing address

1000 EDDY STREET
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-533-9100
  • Fax:
Mailing address:
  • Phone: 401-533-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNNE MALONE
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 401-533-9100