Healthcare Provider Details

I. General information

NPI: 1649395583
Provider Name (Legal Business Name): KEY PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 ATWELLS AVE SUITE 201-D
PROVIDENCE RI
02909-7403
US

IV. Provider business mailing address

670 OLD CONNECTICUT PATH
FRAMINGHAM MA
01701-4548
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-2680
  • Fax: 401-751-6641
Mailing address:
  • Phone: 508-877-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateRI

VIII. Authorized Official

Name: MRS. MARCIA ALLEN
Title or Position: ADMINISTRATIVE SUPERVISOR
Credential:
Phone: 401-861-2680