| NPI | 1164923553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISHA M BOURDEAU CFO 401-275-5038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: RI 605.08) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: RI 605.08) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: RI 605.08) | |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2019-04-25 |