| NPI | 1063574135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND J LAVOIE Executive Director 401-312-9892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: RI ACF01536) |
| Additional Taxonomies | 251S00000X (Licence: RI ACF01536) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2024-03-04 |