Provider Demographics
NPI:1427392075
Name:OCEAN STATE BEHAVIORAL
Entity Type:Organization
Organization Name:OCEAN STATE BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:912-223-9758
Mailing Address - Street 1:2733 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3041
Mailing Address - Country:US
Mailing Address - Phone:401-291-4825
Mailing Address - Fax:401-291-4918
Practice Address - Street 1:2733 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3041
Practice Address - Country:US
Practice Address - Phone:401-291-4825
Practice Address - Fax:401-291-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty