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NPI Code Detail

MEDICARE: COMPREHENSIVE COMMUNITY ACTION, INC.

MEDICARE: COMPREHENSIVE COMMUNITY ACTION, 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
1261QF0400XFederally Qualified Health Center (FQHC)1502RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366441719
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPREHENSIVE COMMUNITY ACTION, INC.
Provider Business Mailing Address
First Line : 311 DORIC AVE
Second Line :
City : CRANSTON
State : RI
Zip : 02910-2903
Country : US
Telephone Number : 401-461-0511
Fax Number : 401-467-9030
Provider Business Practice Location Address
First Line : 1090 CRANSTON ST
Second Line :
City : CRANSTON
State : RI
Zip : 02920-7323
Country : US
Telephone Number : 401-943-1981
Fax Number : 401-943-2846
Authorized Official
Title or Position : CFO
Name : MR. JUSTINE SANDS
Credential :
Telephone Number : 401-562-2249
Provider Enumeration Date : 07/19/2005
Last Update Date : 03/11/2025

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Directions to “COMPREHENSIVE COMMUNITY ACTION, INC. ” Practice Location

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