Healthcare Provider Details

I. General information

NPI: 1487916136
Provider Name (Legal Business Name): EAST BAY COMMUNITY ACTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WAMPANOAG TRL
RIVERSIDE RI
02915-1504
US

IV. Provider business mailing address

100 BULLOCKS POINT
RIVERSIDE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 401-437-1008
  • Fax: 401-433-3042
Mailing address:
  • Phone: 401-437-1008
  • Fax: 401-433-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateRI

VIII. Authorized Official

Name: RILWAN FEYISITAN
Title or Position: CEO
Credential:
Phone: 401-437-1008