Healthcare Provider Details

I. General information

NPI: 1083690044
Provider Name (Legal Business Name): PACE ORGANIZATION OF RHODE ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TRIPPS LANE
RIVERSIDE RI
02915
US

IV. Provider business mailing address

10 TRIPPS LANE
RIVERSIDE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 401-654-4789
  • Fax: 401-654-4660
Mailing address:
  • Phone: 401-654-4789
  • Fax: 401-654-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number19
License Number StateRI

VIII. Authorized Official

Name: CRAIG MCANAUGH
Title or Position: CFO
Credential:
Phone: 401-434-1400