| NPI | 1417959867 |
|---|---|
| Doing Business As | PRAIRIE AVE |
| Entity Type | Organization |
| Authorized Contact | GREGORY YOUNG CFO 401-444-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2017-03-29 |