Provider Demographics
NPI:1609925122
Name:EAST BAY COMMUNITY ACTION PROGRAM
Entity Type:Organization
Organization Name:EAST BAY COMMUNITY ACTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RILWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEYISITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-437-1000
Mailing Address - Street 1:100 BULLOCKS POINT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5351
Mailing Address - Country:US
Mailing Address - Phone:401-437-1008
Mailing Address - Fax:401-433-3042
Practice Address - Street 1:100 BULLOCKS POINT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-5351
Practice Address - Country:US
Practice Address - Phone:401-437-1008
Practice Address - Fax:401-433-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411803Medicare Oscar/Certification
RI709003235Medicare Oscar/Certification