Provider Demographics
NPI:1417955733
Name:DISCOVERY HOUSE UTAH
Entity Type:Organization
Organization Name:DISCOVERY HOUSE UTAH
Other - Org Name:DISCOVERY HOUSE WEST WARWIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-780-2300
Mailing Address - Street 1:66 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1522
Mailing Address - Country:US
Mailing Address - Phone:401-780-2300
Mailing Address - Fax:
Practice Address - Street 1:88 W WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-3871
Practice Address - Country:US
Practice Address - Phone:401-821-8866
Practice Address - Fax:401-821-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI608.3261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1029400OtherBEACON HEALTH STRATEGIES
RI8481061OtherUNITED RITECARE
RI410268OtherBLUECHIP RITECARE
RIDH42856Medicaid
RI8410032OtherUNITED HEALTHCARE