Healthcare Provider Details

I. General information

NPI: 1376708560
Provider Name (Legal Business Name): THUNDERMIST HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

IV. Provider business mailing address

25 JOHN A CUMMINGS WAY STE 203
WOONSOCKET RI
02895-3244
US

V. Phone/Fax

Practice location:
  • Phone: 401-615-2800
  • Fax: 401-615-2805
Mailing address:
  • Phone: 401-767-4100
  • Fax: 401-235-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberACF01610
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberACF01610
License Number StateRI

VIII. Authorized Official

Name: CKARLA AGUDELO
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 401-767-4100