Provider Demographics
NPI:1578859179
Name:WHITMARSH CORPORATION
Entity Type:Organization
Organization Name:WHITMARSH CORPORATION
Other - Org Name:WHITMARSH HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:401-351-7230
Mailing Address - Street 1:1055 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5718
Mailing Address - Country:US
Mailing Address - Phone:401-351-7230
Mailing Address - Fax:401-421-0198
Practice Address - Street 1:1055 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5718
Practice Address - Country:US
Practice Address - Phone:401-351-7230
Practice Address - Fax:401-421-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X, 322D00000X
RI404251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIWC70315OtherMEDICAID PROVIDER ID