1417142761 NPI number — EASTER SEALS RHODE ISLAND

Table of content: (NPI 1417142761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417142761 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:
1417142761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
633 THIRD AVENUE 6TH FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
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:
212-727-4270
Provider Business Mailing Address Fax Number:
212-727-4374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 PHILLIPS ST
Provider Second Line Business Practice Location Address:
UNIT 103
Provider Business Practice Location Address City Name:
NORTH KINGTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02852-5149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-284-1000
Provider Business Practice Location Address Fax Number:
401-284-1006
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHOURY
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
212-727-4270

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ES59506 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3711A 31611 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: ES76201 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: ES68496 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 413366 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 33052-9 . This is a "BLUE CROSS RHODE ISLAND" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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