Provider Demographics
NPI:1851472914
Name:SILVER FERN PRACTICE, LLC
Entity Type:Organization
Organization Name:SILVER FERN PRACTICE, LLC
Other - Org Name:HIGHBAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMINICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-433-4172
Mailing Address - Street 1:4 RICHMOND SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:21 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5301
Practice Address - Country:US
Practice Address - Phone:401-433-4172
Practice Address - Fax:401-433-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5228930001Medicare NSC
RI659082109Medicare PIN