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825 Chalkstone Ave Providence RI 02908-4728 | |
| (401) 456-2363 | |
| (401) 456-6744 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine - Addiction Medicine |
| Location | 825 Chalkstone Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Kenneth Belcher (PRESIDENT, CEO) |
| Authorized Official Contact | 4014562025 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
825 Chalkstone Ave Providence RI 02908-4728 Ph: (401) 456-2525 | 825 Chalkstone Ave Providence RI 02908-4728 Ph: (401) 456-2363 |
| NPI Number | 1457395998 |
|---|---|
| Provider Enumeration Date | 06/15/2006 |
| Last Update Date | 03/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457395998 | NPI | - | NPPES |
| RW18813 | Medicaid | RI |
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