Provider Demographics
NPI:1235255688
Name:CITY OF EAST PROVIDENCE
Entity Type:Organization
Organization Name:CITY OF EAST PROVIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:1401-433-6216
Mailing Address - Street 1:80 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3223
Mailing Address - Country:US
Mailing Address - Phone:401-433-6216
Mailing Address - Fax:
Practice Address - Street 1:80 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-3223
Practice Address - Country:US
Practice Address - Phone:401-433-6216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI(LEA)251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIEP11565Medicaid