1811020431 NPI number — RI DEPT OF HEALTH

Table of content: (NPI 1811020431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811020431 NPI number — RI DEPT OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RI DEPT OF HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811020431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 CAPITOL HILL
Provider Second Line Business Mailing Address:
ATTN M DOMENECH ROOM 209
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02908-5097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-222-7772
Provider Business Mailing Address Fax Number:
401-222-6953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 CAPITOL HL
Provider Second Line Business Practice Location Address:
ATTN M DOMENECH ROOM 209
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02908-5034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-222-7772
Provider Business Practice Location Address Fax Number:
401-222-6953
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARISI
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
KEY ADMINISTRATOR
Authorized Official Telephone Number:
401-222-1402

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)