Healthcare Provider Details

I. General information

NPI: 1306769112
Provider Name (Legal Business Name): KCRS YOUTH EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MONTCALM RD
WARWICK RI
02889-4311
US

IV. Provider business mailing address

PO BOX 28805
PROVIDENCE RI
02908-0805
US

V. Phone/Fax

Practice location:
  • Phone: 401-470-5494
  • Fax:
Mailing address:
  • Phone: 401-470-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KASANDRA DOZIER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-470-5494