Provider Demographics
NPI:1821472135
Name:CHARTER CARE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:CHARTER CARE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-788-1249
Mailing Address - Street 1:466 PUTNAM PIKE
Mailing Address - Street 2:UNIT # 15
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-3000
Mailing Address - Country:US
Mailing Address - Phone:401-949-2010
Mailing Address - Fax:
Practice Address - Street 1:466 PUTNAM PIKE
Practice Address - Street 2:UNIT # 15
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-3000
Practice Address - Country:US
Practice Address - Phone:401-949-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty