Healthcare Provider Details

I. General information

NPI: 1063547776
Provider Name (Legal Business Name): FAMILY SERVICE OF RHODE ISLAND INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 THURBERS AVE
PROVIDENCE RI
02905-4754
US

IV. Provider business mailing address

PO BOX 6688
PROVIDENCE RI
02940-6688
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 Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SUZETTE DURAND
Title or Position: CFO
Credential:
Phone: 401-400-6514