Provider Demographics
NPI:1003005141
Name:HOMAN, SHARON N (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:N
Last Name:HOMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RAILROAD AVE
Mailing Address - Street 2:P.O. BOX 226
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-3206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-3206
Practice Address - Country:US
Practice Address - Phone:401-247-4278
Practice Address - Fax:401-247-4569
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN37196320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness