NPI 1104961242

State of Rhode Island and Providence Plantations

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Pascoag, RI

Practice location

Address: 1710 East Wallum Lake Road, Pascoag, RI 02859-1825
Phone: (401) 567-0990
Mailing address: 1710 E Wallum Lake Rd, Pascoag, RI 02859-1825

Authorised official

Name: Jennifer Rae White
Title: Deputy Cfo
Phone: (401) 462-1343

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X Licence 48 (RI)

Other Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Rhode Island →

Registry record

NPI: 1104961242
Entity type: Organization
NPI issued: 20 Feb 2007
Record last updated: 22 Aug 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.