1265914477 NPI number — OCEAN STATE COUNSELING AND WELLNESS CENTER

Table of content: (NPI 1265914477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265914477 NPI number — OCEAN STATE COUNSELING AND WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN STATE COUNSELING AND WELLNESS CENTER
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:
1265914477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 582
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N SCITUATE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02857-0582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-241-3344
Provider Business Mailing Address Fax Number:
888-456-2467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1395 ATWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02919-4931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-241-3344
Provider Business Practice Location Address Fax Number:
888-458-2467
Provider Enumeration Date:
09/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MCGUIRE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CLINICAL MANAGER
Authorized Official Telephone Number:
401-241-3344

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; 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: "Y" .

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





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