Provider Demographics
NPI:1194002972
Name:NORTHWEST COMMUNITY HEALTH CARE
Entity Type:Organization
Organization Name:NORTHWEST COMMUNITY HEALTH CARE
Other - Org Name:WELLONE BEHAVIORIAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:401-285-5119
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859
Mailing Address - Country:US
Mailing Address - Phone:401-567-0800
Mailing Address - Fax:401-371-2907
Practice Address - Street 1:1 HIGH STREET
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859
Practice Address - Country:US
Practice Address - Phone:401-567-0800
Practice Address - Fax:401-567-0900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST COMMUNITY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-08
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health