Healthcare Provider Details

I. General information

NPI: 1912315755
Provider Name (Legal Business Name): COMMUNITY CARE ALLIANCE AGAPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MAIN ST
WOONSOCKET RI
02895-3123
US

IV. Provider business mailing address

PO BOX 1700
WOONSOCKET RI
02895-0856
US

V. Phone/Fax

Practice location:
  • Phone: 401-766-0900
  • Fax: 401-767-4075
Mailing address:
  • Phone: 401-235-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. RITA GANDHI
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 401-235-6052