Provider Demographics
NPI:1700208899
Name:PRIME HEALTHCARE SERVICES LANDMARK LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES LANDMARK LLC
Other - Org Name:LANDMARK MC OCCUPATIONAL MEDICINE DEPT. NP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-769-4100
Mailing Address - Street 1:196 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4712
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:401-765-6024
Practice Address - Street 1:115 CASS AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4705
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:401-765-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational HealthGroup - Single Specialty