Provider Demographics
NPI:1891869608
Name:JEWISH SENIORS AGENCY OF RHODE ISLAND
Entity Type:Organization
Organization Name:JEWISH SENIORS AGENCY OF RHODE ISLAND
Other - Org Name:THE COMPREHENSIVE ADULT DAY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-351-4750
Mailing Address - Street 1:229 WATERMAN STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-351-4750
Mailing Address - Fax:401-421-5905
Practice Address - Street 1:229 WATERMAN STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-351-4750
Practice Address - Fax:401-421-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITC04772Medicaid