=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245362185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHINGTON PARK CITIZENS ASSOCIATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1279 BROAD ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-461-6650
-----------------------------------------------------
Fax | 401-781-5262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 JILLSON ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-461-6650
-----------------------------------------------------
Fax | 401-781-5262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. FRANCES P MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-461-6650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 43530
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------