Provider Demographics
NPI:1013038462
Name:FRUIT HILL DAY SERVICES FOR ELDERLY
Entity Type:Organization
Organization Name:FRUIT HILL DAY SERVICES FOR ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALINE
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:GIROUX
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS, MBA, MTS
Authorized Official - Phone:401-353-5805
Mailing Address - Street 1:399 FRUIT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2842
Mailing Address - Country:US
Mailing Address - Phone:401-353-5805
Mailing Address - Fax:401-353-4904
Practice Address - Street 1:399 FRUIT HILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2842
Practice Address - Country:US
Practice Address - Phone:401-353-5805
Practice Address - Fax:401-353-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI15261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIFH04082Medicaid