Provider Demographics
NPI:1821254525
Name:NORTHWEST COMMUNITY HEALTH CARE
Entity Type:Organization
Organization Name:NORTHWEST COMMUNITY HEALTH CARE
Other - Org Name:WELLONE PRIMARY MEDICAL AND DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-285-5119
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859
Mailing Address - Country:US
Mailing Address - Phone:401-568-7664
Mailing Address - Fax:401-285-5101
Practice Address - Street 1:142A DANIELSON PIKE
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1475
Practice Address - Country:US
Practice Address - Phone:401-647-3702
Practice Address - Fax:401-647-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINC50602Medicaid
RI411841Medicare PIN