State of Rhode Island and Providence Plantations
NPI #1104961242 in Pascoag, Rhode Island
Provider Information
- NPI Number
- 1104961242
- Entity Type
- Organization
- Organization Name
- State of Rhode Island and Providence Plantations
- Primary Specialty
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Feb 20, 2007
- Last Updated
- Aug 22, 2019
Practice Location
- Address
- 1710 EAST WALLUM LAKE ROAD
- City
- Pascoag
- State
- Rhode Island
- ZIP Code
- 02859-1825
- Phone
- (401) 567-0990
Authorized Official
- Name
- MS. JENNIFER RAE WHITE
- Title
- DEPUTY CFO
- Phone
- (401) 462-1343
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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