Provider Demographics
NPI:1376956342
Name:MICHELLE CRANDALL PCNS LLC
Entity Type:Organization
Organization Name:MICHELLE CRANDALL PCNS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN PCNS
Authorized Official - Phone:401-364-0739
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER JUNCTION
Mailing Address - State:RI
Mailing Address - Zip Code:02894-0204
Mailing Address - Country:US
Mailing Address - Phone:401-364-0739
Mailing Address - Fax:
Practice Address - Street 1:35 DAWN LN
Practice Address - Street 2:
Practice Address - City:WOOD RIVER JUNCTION
Practice Address - State:RI
Practice Address - Zip Code:02894-1001
Practice Address - Country:US
Practice Address - Phone:401-364-0739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00087261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health