Healthcare Provider Details

I. General information

NPI: 1609239920
Provider Name (Legal Business Name): EAST BAY COMMUNITY ACTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BULLOCKS POINT
RIVERSIDE RI
02915
US

IV. Provider business mailing address

100 BULLOCKS POINT
RIVERSIDE RI
02915
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberACF01574
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberACF01574
License Number StateRI

VIII. Authorized Official

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