Provider Demographics
NPI:1790071942
Name:TOWN OF COVENTRY
Entity Type:Organization
Organization Name:TOWN OF COVENTRY
Other - Org Name:PROJECT FRIENDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHURTLEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF ARTS
Authorized Official - Phone:401-822-9175
Mailing Address - Street 1:50 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5825
Mailing Address - Country:US
Mailing Address - Phone:401-822-9175
Mailing Address - Fax:401-822-6211
Practice Address - Street 1:50 WOOD ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5825
Practice Address - Country:US
Practice Address - Phone:401-822-9175
Practice Address - Fax:401-822-6211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF COVENTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI367251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITC55699Medicaid