Provider Demographics
NPI:1942051263
Name:LIFE OF PEACE CENTER
Entity Type:Organization
Organization Name:LIFE OF PEACE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:401-744-9322
Mailing Address - Street 1:390 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3322
Mailing Address - Country:US
Mailing Address - Phone:401-744-9322
Mailing Address - Fax:
Practice Address - Street 1:390 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3322
Practice Address - Country:US
Practice Address - Phone:401-744-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)