Provider Demographics
NPI:1811020431
Name:RI DEPT OF HEALTH
Entity Type:Organization
Organization Name:RI DEPT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:KEY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-222-1402
Mailing Address - Street 1:3 CAPITOL HILL
Mailing Address - Street 2:ATTN M DOMENECH ROOM 209
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5097
Mailing Address - Country:US
Mailing Address - Phone:401-222-7772
Mailing Address - Fax:401-222-6953
Practice Address - Street 1:3 CAPITOL HL
Practice Address - Street 2:ATTN M DOMENECH ROOM 209
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5034
Practice Address - Country:US
Practice Address - Phone:401-222-7772
Practice Address - Fax:401-222-6953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI=========Medicaid