Provider Demographics
NPI:1083690044
Name:PACE ORGANIZATION OF RI
Entity Type:Organization
Organization Name:PACE ORGANIZATION OF RI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWIATKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-490-7610
Mailing Address - Street 1:225 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4533
Mailing Address - Country:US
Mailing Address - Phone:401-490-6566
Mailing Address - Fax:401-490-7614
Practice Address - Street 1:225 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4533
Practice Address - Country:US
Practice Address - Phone:401-490-6566
Practice Address - Fax:401-490-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI19302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
H4105OtherPACE DHS CONTRACT #