MEDICARE: KINGSTON HILL ACADEMY,INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251S00000X	Community/Behavioral Health Agency
4	251300000X	Local Education Agency (LEA)

Other Identifiers

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

General Provider Information

NPI Number	:	1801911565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSTON HILL ACADEMY,INC

Provider Business Mailing Address
First Line	:	610 MANTON AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02909-5633
Country	:	US
Telephone Number	:	401-274-6310
Fax Number	:	401-421-1077

Provider Business Practice Location Address
First Line	:	850 STONY FORT RD
Second Line	:
City	:	SAUNDERSTOWN
State	:	RI
Zip	:	02874-1003
Country	:	US
Telephone Number	:	401-274-6310
Fax Number	:	401-421-1077

Authorized Official
Title or Position	:	CHIEF ADMINISTRATOR
Name	:	MARCELLA TERRANOVA CLARK
Credential	:
Telephone Number	:	401-783-8282

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	10/10/2024

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Directions to “KINGSTON HILL ACADEMY,INC ” Practice Location

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