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General NPI Number Information
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NPI Number | 1164065140
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Entity Type | Organization
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Legal Business Name | THE FOGARTY CENTER
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 310 MAPLE AVE STE 102
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City | BARRINGTON
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State | RI
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Zip | 02806-3431
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Country | US
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Telephone | 401-245-7900
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Fax | 401-245-7910
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Provider Business Mailing Address
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Address Line | 310 MAPLE AVE STE 102
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City | BARRINGTON
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State | RI
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Zip | 02806-3431
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Country | US
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Telephone | 401-245-7900
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Fax | 401-245-7910
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Authorized Official
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Title or Position | CFO
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Name | MICHELLE C BRODEUR
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Credential |
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Telephone | 401-245-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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