Healthcare Provider Details

I. General information

NPI: 1801911565
Provider Name (Legal Business Name): KINGSTON HILL ACADEMY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 STONY FORT RD
SAUNDERSTOWN RI
02874-1003
US

IV. Provider business mailing address

610 MANTON AVE
PROVIDENCE RI
02909-5633
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-6310
  • Fax: 401-421-1077
Mailing address:
  • Phone: 401-274-6310
  • Fax: 401-421-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA TERRANOVA CLARK
Title or Position: CHIEF ADMINISTRATOR
Credential:
Phone: 401-783-8282