Provider Demographics
NPI:1174818504
Name:RI COMMUNITY LIVING AND SUPPORTS
Entity Type:Organization
Organization Name:RI COMMUNITY LIVING AND SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:STENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-462-2339
Mailing Address - Street 1:6 HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3080
Mailing Address - Country:US
Mailing Address - Phone:401-462-2659
Mailing Address - Fax:401-462-6631
Practice Address - Street 1:6 HARRINGTON RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3080
Practice Address - Country:US
Practice Address - Phone:401-462-2659
Practice Address - Fax:401-462-6631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF RHODE ISLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI364251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRI67464Medicaid