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General NPI Number Information
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NPI Number | 1265190292
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Entity Type | Organization
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Legal Business Name | THUNDERMIST HEALTH CENTER
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 360 KINGSTOWN RD UNIT 101
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City | NARRAGANSETT
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State | RI
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Zip | 02882-3258
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Country | US
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Telephone | 401-767-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 25 JOHN A CUMMINGS WAY STE 204
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City | WOONSOCKET
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State | RI
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Zip | 02895-3244
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Country | US
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Telephone | 401-767-4100
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Fax | 401-235-6833
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | CKARLA AGUDELO
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Credential |
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Telephone | 401-767-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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