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General NPI Number Information
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NPI Number | 1215005103
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Entity Type | Organization
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Legal Business Name | CITY OF EAST PROVIDENCE
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 80 BURNSIDE AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-3223
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Country | US
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Telephone | 401-433-6216
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Fax | 401-433-4666
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Provider Business Mailing Address
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Address Line | 80 BURNSIDE AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-3223
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Country | US
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Telephone | 401-433-6216
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Fax | 401-433-4666
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Authorized Official
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Title or Position | MEDICAID COORDINATOR
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Name | MS. AURORA DUARTE
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Credential | B.A.
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Telephone | 401-433-4216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | RI
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