| NPI | 1801152947 |
|---|---|
| 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 SBH00010) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: RI SBH00010) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2018-09-19 |