MEDICARE: URBAN LEAGUE 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	251B00000X	Case Management Agency		RI

General Provider Information

NPI Number	:	1760608228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN LEAGUE OF RHODE ISLAND, INC

Provider Business Mailing Address
First Line	:	246 PRAIRIE AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02905-2333
Country	:	US
Telephone Number	:	401-351-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 PRAIRIE AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02905-2333
Country	:	US
Telephone Number	:	401-351-5000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DENNIS B LANGLEY
Credential	:
Telephone Number	:	401-351-5000

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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