Provider Demographics
NPI:1164829024
Name:EAST PROVIDENCE SENIOR CENTER
Entity Type:Organization
Organization Name:EAST PROVIDENCE SENIOR CENTER
Other - Org Name:DSMT AT EAST PROVIDENCE SENIOR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-435-7800
Mailing Address - Street 1:610 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2427
Mailing Address - Country:US
Mailing Address - Phone:401-435-7800
Mailing Address - Fax:401-435-7803
Practice Address - Street 1:610 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2427
Practice Address - Country:US
Practice Address - Phone:401-435-7800
Practice Address - Fax:401-435-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health