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General NPI Number Information
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NPI Number | 1871079863
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Entity Type | Organization
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Legal Business Name | EASTER SEALS RHODE ISLAND
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 662 HARTFORD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02909-5917
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Country | US
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Telephone | 401-854-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 633 THIRD AVEUNE 6TH FLOOR
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City | NY
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State | NY
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Zip | 10017-6701
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Country | US
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Telephone | 212-727-4300
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Fax |
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Authorized Official
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Title or Position | CFO-ESCT
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Name | MIA MARTIN
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Credential |
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Telephone | 512-615-6811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 848.00
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License Number State | RI
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