| Embrace Healing Psychiatric Services, Llc | |
|
345 Blackstone Blvd Providence RI 02906-4800 | |
| (401) 455-6357 | |
| (401) 455-3566 |
| Full Name | Embrace Healing Psychiatric Services, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 345 Blackstone Blvd, Providence, Rhode Island |
| Authorized Official Name and Position | Ghulam Mustafa Surti (PRESIDENT) |
| Authorized Official Contact | 4014556357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Embrace Healing Psychiatric Services, Llc 345 Blackstone Blvd Providence RI 02906-4800 Ph: (401) 455-6357 | Embrace Healing Psychiatric Services, Llc 345 Blackstone Blvd Providence RI 02906-4800 Ph: (401) 455-6357 |
| NPI Number | 1679977342 |
|---|---|
| Provider Enumeration Date | 10/09/2014 |
| Last Update Date | 10/09/2014 |
| Medicare PECOS PAC ID | 8820379621 |
|---|---|
| Medicare Enrollment ID | O20170111000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679977342 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD09937 (Rhode Island) | Primary |
| Provider Name | Ghulam Mustafa Surti |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861499675 PECOS PAC ID: 1456331354 Enrollment ID: I20040721001569 |
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