Healthcare Provider Details

I. General information

NPI: 1104975408
Provider Name (Legal Business Name): GRODEN CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 BRANCH PIKE
SMITHFIELD RI
02917-1211
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 TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number45412
License Number StateRI

VIII. Authorized Official

Name: GRACE TOE
Title or Position: CFO
Credential:
Phone: 401-274-6310