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General NPI Number Information
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NPI Number | 1871780908
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Entity Type | Organization
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Legal Business Name | IRIE TRANSITIONAL PROGRAM
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 55 S BROW ST
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-4433
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Country | US
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Telephone | 401-497-8109
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Fax | 401-349-5160
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Provider Business Mailing Address
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Address Line | 55 S BROW ST
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-4433
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Country | US
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Telephone | 401-497-8109
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Fax | 401-349-5160
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Authorized Official
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Title or Position | CEO
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Name | MRS. AMANDA DEE TUMMINELLI
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Credential | MBA
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Telephone | 401-497-8109
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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 |
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | RI
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