| NPI | 1659845451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTINE SANDS CFO 401-562-2249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2024-05-08 |