STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS (NPI# 1104961242) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104961242 |
Entity Type | Organization |
Organization Name | STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS |
Other Organization Name | EAST WALLUM LAKE GROUP HOME |
Practice Address |
1710 East Wallum Lake Road Pascoag RI 02859-1825 |
Mailing Address |
1710 E Wallum Lake Rd Pascoag RI 02859-1825 |
Practice Telephone | 4015670990 |
Mailing Telephone | 4015670990 |
Mailing Fax Number | 4015670147 |
Enumeration Date | 2007-02-20 |
Last Update Date | 2019-08-22 |
Authorized Official Name | MS. JENNIFER RAE WHITE (DEPUTY CFO) |
Authorized Official Telephone | 4014621343 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 48 | RI | Residential Treatment Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
RI | EW12083 | 05 |
Other Name | Type Code |
---|---|
East Wallum Lake Group Home | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164567202 | State of Rhode Island and Providence Plantations | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 80 Mowry Avenue, North Smithfield, RI 02896-7110 | 2007-02-20 |
1174690887 | State of Rhode Island and Providence Plantations | Clinical Medical Laboratory | 50 Orms St, Providence, RI 02904-2222 | 2006-11-29 |
1497850499 | State of Rhode Island and Providence Plantations | Speech-Language Pathologist | 25 W Independence Way Ste I, Kingston, RI 02881-1124 | 2006-09-14 |
1801889035 | State of Rhode Island and Providence Plantations | Long Term Care Hospital | 111 Howard Ave, Cranston, RI 02920-3001 | 2005-08-23 |
1962536730 | State of Rhode Island and Providence Plantations | Public Health or Welfare | 3 Capitol Hl, Room 402, Providence, RI 02908-5034 | 2007-03-15 |
1922197789 | State of Rhode Island and Providence Plantations | Long Term Care Hospital | 111 Howard Ave, Cranston, RI 02920-3001 | 2006-10-12 |
Street Address |
1710 EAST WALLUM LAKE ROAD |
City | PASCOAG |
State | RI |
Zip Code | 02859-1825 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811397763 | Patricia Scuncio | Physical Therapy Assistant | 252 Donahue Road, Pascoag, RI 02859 | 2014-08-28 |
1134479520 | Kimberly Mary Cote | Social Worker | 2078 Wallum Lake Rd., Pascoag, RI 02859 | 2012-09-13 |
1487923793 | Northwest Community Health Care | Clinic/Center | 999 S. Main Street, Pascoag, RI 02859 | 2011-12-16 |
1730343666 | James Edward Sullivan | Counselor | 2076 Wallum Lake Rd, Pascoag, RI 02859 | 2008-07-10 |
1427243682 | Julie A. Vander Schel | Counselor | 2076 Wallum Lake Road, Pascoag, RI 02859 | 2007-09-11 |
1699985226 | Donna Watson | Counselor | 2198 Wallum Lake Rd., Pascoag, RI 02859 | 2007-05-23 |
1194817197 | Purvi Chokshi | Internal Medicine | 2090 Wallum Lake Road, Pascoag, RI 02859 | 2006-09-28 |
1659395622 | Dennis Edward Joyce | Counselor | 2198 Wallum Lake Road, Pascoag, RI 02859 | 2006-07-26 |
1427087782 | Robert James Brothers | Counselor | 2198 Wallum Lake Rd, Pascoag, RI 02859 | 2006-06-30 |
1245219070 | Northwest Community Health Care | Clinic/Center | 36 Bridge Way, Pascoag, RI 02859 | 2006-01-11 |
Find all providers in zip 02859 |
Taxonomy Code | 320900000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639307176 | Perspectives Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 53 Dockray Street, Wakefield, RI 02879 | 2009-06-23 |
1740302082 | Spurwinkri-brook Drive | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10 Brook Dr, Hope Valley, RI 02832-2504 | 2007-04-06 |
1275655425 | Spurwink Ri - Crompton Road | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 106 Crompton Rd, East Greenwich, RI 02818-1202 | 2007-04-06 |
1699897942 | Spurwink Ri-south County Trail | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2944 S County Trl, East Greenwich, RI 02818-1429 | 2007-04-06 |
1700908969 | Spurwink Ri - Peaked Rock Road | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 33 Peaked Rock Rd, Wakefield, RI 02879-2380 | 2007-04-06 |
1235251489 | Spurwink Ri - Seven Mile Road | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 569 Seven Mile Rd, Hope, RI 02831-1850 | 2007-04-06 |
1467574624 | Spurwink Ri - Plainfield Pike | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1150 Plainfield Pike, Cpu Summit General Store, RI 02827-1904 | 2007-04-06 |
1881713733 | Re-focus Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 18 11th St, Providence, RI 02906-2910 | 2007-03-29 |
1982723987 | Re-focus Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7 Cooke Dr, North Scituate, RI 02857-1609 | 2007-03-29 |
1154440188 | Re-focus Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 179 Bourne St, North Providence, RI 02904-3707 | 2007-03-29 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.