1669428348 NPI number — EAST BAY CENTER, INC.

Table of content: (NPI 1669428348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669428348 NPI number — EAST BAY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST BAY CENTER, 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:
1669428348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 OLD COUNTY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02806-1602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-437-8844
Provider Business Mailing Address Fax Number:
401-437-8847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 OLD COUNTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02806-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-437-8844
Provider Business Practice Location Address Fax Number:
401-437-8847
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROSSLEY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICERF
Authorized Official Telephone Number:
401-437-8844

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  623 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: 623 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 623 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 29206-5 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 23501 . This is a "UBH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: BCG0001107 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: CPG0001107 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1016900 . This is a "NHPRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 900-1872 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30738-9 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 408215 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 410862 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 412121 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 84-60036 . This is a "UBH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: EB02290 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6963 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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