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825 Chalkstone Ave Providence RI 02908-4728 | |
| (401) 456-2000 | |
| (401) 456-2029 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 825 Chalkstone Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Robert Jon Elders (SECRETARY) |
| Authorized Official Contact | 7147881249 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
825 Chalkstone Ave Providence RI 02908-4728 Ph: (401) 456-2000 | 825 Chalkstone Ave Providence RI 02908-4728 Ph: (401) 456-2000 |
| NPI Number | 1477978476 |
|---|---|
| Provider Enumeration Date | 02/27/2014 |
| Last Update Date | 01/11/2021 |
| Certification Date | 01/11/2021 |
| Medicare PECOS PAC ID | 0547492696 |
|---|---|
| Medicare Enrollment ID | O20140404000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477978476 | NPI | - | NPPES |
| 4100004 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | HOS00108 (Rhode Island) | Primary |
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