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General NPI Number Information
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NPI Number | 1801152947
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Entity Type | Organization
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Legal Business Name | THUNDERMIST HEALTH CENTER
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 777 CASS AVE HIGH SCHOOL HEALTH CLINIC
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City | WOONSOCKET
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State | RI
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Zip | 02895-4719
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Country | US
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Telephone | 401-767-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 25 JOHN A CUMMINGS WAY STE 203
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City | WOONSOCKET
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State | RI
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Zip | 02895-3244
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Country | US
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Telephone | 401-767-4100
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | CKARLA AGUDELO
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Credential |
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Telephone | 401-767-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SBH00010
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | SBH00010
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License Number State | RI
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