| The Providence Community Health Centers, Inc. | |
|
335 Prairie Ave Providence RI 02905-1924 | |
| (401) 444-0570 | |
| (401) 444-0427 |
| Full Name | The Providence Community Health Centers, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 335 Prairie Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Gregory Young (VP/CFO) |
| Authorized Official Contact | 4014440400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Providence Community Health Centers, Inc. 375 Allens Ave Providence RI 02905-5010 Ph: (401) 444-0400 | The Providence Community Health Centers, Inc. 335 Prairie Ave Providence RI 02905-1924 Ph: (401) 444-0570 |
| NPI Number | 1215478219 |
|---|---|
| Provider Enumeration Date | 03/10/2017 |
| Last Update Date | 03/10/2017 |
| Medicare PECOS PAC ID | 9335050962 |
|---|---|
| Medicare Enrollment ID | O20170330000924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215478219 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | ACF01613-01 (Rhode Island) | Primary |
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