| NPI | 1083138572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA CHARPENTIER Credentialing Specialist 401-780-2511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: RI ACF01515-01) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-27 |