=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174521488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R.I.S.A.T., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 66 PAVILION AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-461-9110
-----------------------------------------------------
Fax | 401-461-9194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6183 PASEO DEL NORTE STE 200
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92011-1151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-861-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP & SECRETARY
-----------------------------------------------------
Name | BRIAN PHILLIP FARLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-716-9335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 608
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 608
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM2800X
-----------------------------------------------------
Taxonomy Name | Methadone Clinic
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------