Healthcare Provider Details

I. General information

NPI: 1215005103
Provider Name (Legal Business Name): CITY OF EAST PROVIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 BURNSIDE AVE
RIVERSIDE RI
02915-3223
US

IV. Provider business mailing address

80 BURNSIDE AVE
RIVERSIDE RI
02915-3223
US

V. Phone/Fax

Practice location:
  • Phone: 401-433-6216
  • Fax: 401-433-4666
Mailing address:
  • Phone: 401-433-6216
  • Fax: 401-433-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateRI

VIII. Authorized Official

Name: MS. AURORA DUARTE
Title or Position: MEDICAID COORDINATOR
Credential: B.A.
Phone: 401-433-4216