Provider Demographics
NPI:1194865964
Name:SOUTHERN RI REGIONAL COLLABORATIVE
Entity Type:Organization
Organization Name:SOUTHERN RI REGIONAL COLLABORATIVE
Other - Org Name:FORWARDVIEW ACADEMY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZANN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-295-2888
Mailing Address - Street 1:646 CAMP AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4008
Mailing Address - Country:US
Mailing Address - Phone:401-295-2888
Mailing Address - Fax:401-295-3232
Practice Address - Street 1:646 CAMP AVE
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4008
Practice Address - Country:US
Practice Address - Phone:401-295-2888
Practice Address - Fax:401-295-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty