=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235335704
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGITRACE CARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2007
-----------------------------------------------------
Last Update Date | 05/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 W EXCHANGE ST STE 100B
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-831-0607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CORPORATE PL SUITE 5B
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF FINANCE AND ADMINISTRATION
-----------------------------------------------------
Name | JOSEPH ROSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-536-6105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------