Healthcare Provider Details

I. General information

NPI: 1942419494
Provider Name (Legal Business Name): ACTION BASED ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MAIN ST
WOONSOCKET RI
02895-4330
US

IV. Provider business mailing address

PO BOX 19038
JOHNSTON RI
02919-0038
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-5959
  • Fax: 401-767-5957
Mailing address:
  • Phone: 401-767-5959
  • Fax: 401-767-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number399
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT ANTHONY PURCELL
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential: M.ED
Phone: 401-767-5959