Provider Demographics
NPI:1821323940
Name:THE FOGARTY CENTER
Entity Type:Organization
Organization Name:THE FOGARTY CENTER
Other - Org Name:PERSONAL CHOICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-245-7900
Mailing Address - Street 1:310 MAPLE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3430
Mailing Address - Country:US
Mailing Address - Phone:401-245-7900
Mailing Address - Fax:401-245-7910
Practice Address - Street 1:310 MAPLE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3430
Practice Address - Country:US
Practice Address - Phone:401-245-7900
Practice Address - Fax:401-245-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI183253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOS59568OtherDHS - STATE OF RI