1992884787 NPI number — PHOENIX HOUSES OF NEW ENGLAND, INC.

Table of content: (NPI 1992884787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992884787 NPI number — PHOENIX HOUSES OF NEW ENGLAND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX HOUSES OF NEW ENGLAND, INC.
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:
1992884787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 WAYLAND AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-4314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-331-4250
Provider Business Mailing Address Fax Number:
401-421-5520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 WAYLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-4314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-331-4250
Provider Business Practice Location Address Fax Number:
401-421-5520
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUMMA
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
401-331-4250

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 621 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: CMC 00028 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X , with the licence number: 02725 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 0296 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 410878 . This is a "BC RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9202 . This is a "NHP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9515 . This is a "NHP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 15601000 . This is a "MAINECARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 15601001 . This is a "MAINECARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 203388 . This is a "BC RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA04867 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6988 . This is a "BC RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30766 . This is a "BC RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1009585 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006554 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009358 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410875 . This is a "BC RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9203 . This is a "NHP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1002232 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30007117 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30763 . This is a "BC RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 467656 . This is a "MOHEGAN SUN VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9192 . This is a "NHP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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