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General NPI Number Information
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NPI Number | 1417955733
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Entity Type | Organization
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Legal Business Name | DISCOVERY HOUSE UTAH
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 88 W WARWICK AVE
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City | WEST WARWICK
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State | RI
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Zip | 02893-3871
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Country | US
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Telephone | 401-821-8866
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Fax | 401-821-1319
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Provider Business Mailing Address
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Address Line | 66 PAVILION AVE
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City | PROVIDENCE
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State | RI
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Zip | 02905-1522
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Country | US
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Telephone | 401-780-2300
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | PETER MORRIS
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Credential |
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Telephone | 401-780-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 608.3
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License Number State | RI
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