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General NPI Number Information
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NPI Number | 1487534962
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Entity Type | Organization
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Legal Business Name | HAUS OF CODEC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 115 EMPIRE ST STE 101
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City | PROVIDENCE
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State | RI
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Zip | 02903-3254
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Country | US
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Telephone | 401-484-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 53 BROAD ST PO BOX 23360
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City | PROVIDENCE
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State | RI
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Zip | 02903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS & DEVELOPMEN
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Name | GEORGE MARLEY
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Credential |
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Telephone | 401-484-7465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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