Provider Demographics
NPI:1114961729
Name:ROGER WILLIAMS MEDICAL CENTER
Entity Type:Organization
Organization Name:ROGER WILLIAMS MEDICAL CENTER
Other - Org Name:CHARTERCARE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WERBER FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:401-456-2101
Mailing Address - Street 1:50 MAUDE STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908
Mailing Address - Country:US
Mailing Address - Phone:401-456-2273
Mailing Address - Fax:401-456-2514
Practice Address - Street 1:50 MAUDE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4325
Practice Address - Country:US
Practice Address - Phone:401-456-2273
Practice Address - Fax:401-456-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHNC02226251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI417029Medicare UPIN