Provider Demographics
NPI:1649206293
Name:GOTHAM PER DIEM, INC.
Entity Type:Organization
Organization Name:GOTHAM PER DIEM, INC.
Other - Org Name:ALTERNATIVE CARE MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-228-1994
Mailing Address - Street 1:304 PEARL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2215
Mailing Address - Country:US
Mailing Address - Phone:401-351-1818
Mailing Address - Fax:401-351-1854
Practice Address - Street 1:304 PEARL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2215
Practice Address - Country:US
Practice Address - Phone:401-351-1818
Practice Address - Fax:401-351-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 02268251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAC33095Medicaid
RIAC32832Medicaid