=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811496664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVERSITY ADULT DAY HEALTH CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2018
-----------------------------------------------------
Last Update Date | 02/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 ELMWOOD AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02907-1766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-427-1337
-----------------------------------------------------
Fax | 401-369-7818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 433 ELMWOOD AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02907-1766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-427-1337
-----------------------------------------------------
Fax | 401-369-7818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. COLIN P HANRAHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-427-1337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | ADC00048
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------