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General NPI Number Information
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NPI Number | 1790071942
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Entity Type | Organization
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Legal Business Name | TOWN OF COVENTRY
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 50 WOOD ST
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City | COVENTRY
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State | RI
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Zip | 02816-5825
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Country | US
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Telephone | 401-822-9175
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Fax | 401-822-6211
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Provider Business Mailing Address
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Address Line | 50 WOOD ST
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City | COVENTRY
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State | RI
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Zip | 02816-5825
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Country | US
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Telephone | 401-822-9175
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Fax | 401-822-6211
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. PATRICIA SHURTLEFF
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Credential | MASTER OF ARTS
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Telephone | 401-822-9175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 367
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License Number State | RI
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