Provider Demographics
NPI:1558768663
Name:EAST PROVIDENCE SENIOR CENTER
Entity Type:Organization
Organization Name:EAST PROVIDENCE SENIOR CENTER
Other - Org Name:DSMT PROGRAM HEALTH NUTRITION DIABETES OFFICE EPSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-435-7800
Mailing Address - Street 1:610 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2427
Mailing Address - Country:US
Mailing Address - Phone:401-435-7800
Mailing Address - Fax:401-435-7803
Practice Address - Street 1:610 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2427
Practice Address - Country:US
Practice Address - Phone:401-435-7800
Practice Address - Fax:401-435-7803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF EAST PROVIDENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty