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General NPI Number Information
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NPI Number | 1124738281
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Entity Type | Organization
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Legal Business Name | RHODE ISLAND COMMUNITY LIVING AND SUPPORTS (RICLAS)
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 45 LAKEHURST DRIVE
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City | COVENTRY
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State | RI
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Zip | 02816
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Country | US
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Telephone | 401-462-5332
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Fax | 401-462-2804
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Provider Business Mailing Address
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Address Line | 6 HARRINGTON ROAD
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City | CRANSTON
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State | RI
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Zip | 02920
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Country | US
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Telephone | 401-462-5332
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Fax | 401-462-2804
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Authorized Official
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Title or Position | DIRECTOR
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Name | RICHARD R CHAREST
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Credential |
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Telephone | 401-462-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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