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General NPI Number Information
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NPI Number | 1396722666
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE SERVICES-LANDMARK LLC
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 115 CASS AVE
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City | WOONSOCKET
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State | RI
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Zip | 02895-4705
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Country | US
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Telephone | 401-769-4100
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Fax | 401-765-6024
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Provider Business Mailing Address
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Address Line | 196 CASS AVE
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City | WOONSOCKET
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State | RI
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Zip | 02895-4712
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Country | US
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Telephone | 401-769-4100
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Fax | 401-765-6024
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD CHAREST
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Credential |
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Telephone | 401-769-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 00117
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License Number State | RI
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