MEDICARE: UNITED CEREBRAL PALSY OF RHODE ISLAND, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency	244	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UC54947	OTHER	RI	CW FUNDING

General Provider Information

NPI Number	:	1285707950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY OF RHODE ISLAND, INC.

Provider Business Mailing Address
First Line	:	200 MAIN ST
Second Line	:	SUITE 210
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-4119
Country	:	US
Telephone Number	:	401-728-1800
Fax Number	:	401-728-0182

Provider Business Practice Location Address
First Line	:	200 MAIN ST
Second Line	:	SUITE 210
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-4119
Country	:	US
Telephone Number	:	401-728-1800
Fax Number	:	401-728-0182

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE, CFO
Name	:	MR. KARL P PROVOST
Credential	:
Telephone Number	:	401-728-1800

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	06/22/2011

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