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General NPI Number Information
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NPI Number | 1508462128
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Entity Type | Organization
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Legal Business Name | OCEAN STATE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1524 ATWOOD AVE STE 244
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City | JOHNSTON
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State | RI
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Zip | 02919-3228
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Country | US
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Telephone | 401-626-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 ATWOOD AVE STE 244
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City | JOHNSTON
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State | RI
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Zip | 02919-3228
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Country | US
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Telephone | 401-626-0169
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | CHRISTOPHER DORVAL
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Credential | LICSW
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Telephone | 401-626-0169
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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 |
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License Number State |
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