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345 Blackstone Blvd Providence RI 02906-4800 | |
| (917) 447-2138 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Addiction Medicine |
| Location | 345 Blackstone Blvd, Providence, Rhode Island |
| Authorized Official Name and Position | Kevin Elliot Baill (PRESIDENT) |
| Authorized Official Contact | 9174472138 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 603198 Providence RI 02906-0198 Ph: () - | 345 Blackstone Blvd Providence RI 02906-4800 Ph: (917) 447-2138 |
| NPI Number | 1205259793 |
|---|---|
| Provider Enumeration Date | 02/04/2014 |
| Last Update Date | 03/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205259793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | 12179 (Rhode Island) | Primary |
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