Healthcare Provider Details

I. General information

NPI: 1609925122
Provider Name (Legal Business Name): EAST BAY COMMUNITY ACTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BULLOCKS POINT AVE
RIVERSIDE RI
02915-5351
US

IV. Provider business mailing address

100 BULLOCKS POINT AVE
RIVERSIDE RI
02915-5351
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 TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RILWAN FEYISITAN
Title or Position: CEO
Credential:
Phone: 401-437-1000