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General NPI Number Information
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NPI Number | 1598255168
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Entity Type | Organization
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Legal Business Name | CCSRI, LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 650 TEN ROD RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-4238
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Country | US
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Telephone | 301-809-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 COLLINGTON RD
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City | BOWIE
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State | MD
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Zip | 20716-2259
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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 | AVP, COMPLIANCE AND DELEGATION
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Name | VERONICA PICKENS
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Credential |
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Telephone | 301-809-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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