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General NPI Number Information
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NPI Number | 1134264062
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH HEALTH SERVICES OF RI
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 21 PEACE ST
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City | PROVIDENCE
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State | RI
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Zip | 02907-1510
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Country | US
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Telephone | 401-456-4325
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Fax | 401-456-4250
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Provider Business Mailing Address
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Address Line | 200 HIGH SERVICE AVE ATTN: ROSE SOARES
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-5113
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Country | US
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Telephone | 401-456-2525
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Fax | 401-456-6742
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Authorized Official
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Title or Position | SNR. VISE PRESIDENT
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Name | MICHAEL CONKLIN
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Credential | CFO
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Telephone | 401-456-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | HOS00110
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | HOS00110
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License Number State | RI
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