Provider Demographics
NPI:1245617422
Name:WHITESTONE LIFE CENTER INC
Entity Type:Organization
Organization Name:WHITESTONE LIFE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FALU
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCDP LCDS
Authorized Official - Phone:401-523-7520
Mailing Address - Street 1:475 CRANSTON ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2744
Mailing Address - Country:US
Mailing Address - Phone:401-523-7520
Mailing Address - Fax:
Practice Address - Street 1:475 CRANSTON ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2744
Practice Address - Country:US
Practice Address - Phone:401-523-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty