Provider Demographics
NPI:1043266232
Name:APPLE VALLEY FAMILY TREATMENT CENTER
Entity Type:Organization
Organization Name:APPLE VALLEY FAMILY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-949-2010
Mailing Address - Street 1:466 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-3002
Mailing Address - Country:US
Mailing Address - Phone:401-949-2010
Mailing Address - Fax:401-949-4140
Practice Address - Street 1:466 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-3002
Practice Address - Country:US
Practice Address - Phone:401-949-2010
Practice Address - Fax:401-949-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty