| NPI | 1700041001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CKARLA AGUDELO Credentialing Specialist 401-767-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: RI ACF01566) |
| Additional Taxonomies | 251S00000X (Licence: RI ACF01566) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2019-06-06 |