Provider Demographics
NPI:1275655425
Name:SPURWINK RI - CROMPTON ROAD
Entity Type:Organization
Organization Name:SPURWINK RI - CROMPTON ROAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-781-4380
Mailing Address - Street 1:1 SPURWINK PL
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2012
Mailing Address - Country:US
Mailing Address - Phone:401-781-4380
Mailing Address - Fax:
Practice Address - Street 1:106 CROMPTON RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1202
Practice Address - Country:US
Practice Address - Phone:401-828-4323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI166OtherMHRH-DDD
RIL-9145Medicaid