Provider Demographics
NPI:1639819766
Name:RHODE ISLAND COMMUNITY LIVING AND SUPPORTS (RICLAS)
Entity Type:Organization
Organization Name:RHODE ISLAND COMMUNITY LIVING AND SUPPORTS (RICLAS)
Other - Org Name:18 REDDINGTON STREET GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-462-0917
Mailing Address - Street 1:6 HARRINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-462-5332
Mailing Address - Fax:401-462-2804
Practice Address - Street 1:18 REDDINGTON STREET
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-4246
Practice Address - Country:US
Practice Address - Phone:401-462-5332
Practice Address - Fax:401-462-2804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RI COMMUNITY LIVING AND SUPPORTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-29
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities