Healthcare Provider Details

I. General information

NPI: 1609818210
Provider Name (Legal Business Name): THE PROVIDENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PLAIN ST
PROVIDENCE RI
02903-4817
US

IV. Provider business mailing address

951 N MAIN ST
PROVIDENCE RI
02904-5759
US

V. Phone/Fax

Practice location:
  • Phone: 401-528-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number631.8
License Number StateRI

VIII. Authorized Official

Name: DONNA RICHARD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 401-528-0140