1871079863 NPI number — EASTER SEALS RHODE ISLAND

Table of content: (NPI 1871079863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871079863 NPI number — EASTER SEALS RHODE ISLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS RHODE ISLAND
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:
1871079863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
633 THIRD AVEUNE 6TH FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-6701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-727-4300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
662 HARTFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02909-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-854-9353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
MIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO-ESCT
Authorized Official Telephone Number:
512-615-6811

Provider Taxonomy Codes

  • Taxonomy code: 385HR2060X , with the licence number:  848.00 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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