Healthcare Provider Details

I. General information

NPI: 1235264797
Provider Name (Legal Business Name): LIVING IN FULFILLING ENVIRONMENTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 FORBES ST
RIVERSIDE RI
02915-1621
US

IV. Provider business mailing address

PO BOX 449
TIVERTON RI
02878-0449
US

V. Phone/Fax

Practice location:
  • Phone: 401-254-2910
  • Fax:
Mailing address:
  • Phone: 401-254-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number154
License Number StateRI

VIII. Authorized Official

Name: ALEX MARTLAND-KILE
Title or Position: BOOKKEEPER
Credential:
Phone: 401-254-2910