MEDICARE: THE PROVIDENCE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1043240799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PROVIDENCE CENTER

Provider Business Mailing Address
First Line	:	530 N MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-5762
Country	:	US
Telephone Number	:	401-274-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 CENTERVILLE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4397
Country	:	US
Telephone Number	:	401-274-2500
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	CARLA SOSA
Credential	:
Telephone Number	:	401-921-7386

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/11/2026

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Directions to “THE PROVIDENCE CENTER ” Practice Location

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