Healthcare Provider Details

I. General information

NPI: 1245362185
Provider Name (Legal Business Name): WASHINGTON PARK CITIZENS ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 BROAD ST
PROVIDENCE RI
02905-2935
US

IV. Provider business mailing address

42 JILLSON ST
PROVIDENCE RI
02905-2904
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-6650
  • Fax: 401-781-5262
Mailing address:
  • Phone: 401-461-6650
  • Fax: 401-781-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number43530
License Number StateRI

VIII. Authorized Official

Name: MS. FRANCES P MURPHY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-461-6650