Provider Demographics
NPI:1942419494
Name:ACTION BASED ENTERPRISES
Entity Type:Organization
Organization Name:ACTION BASED ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:401-767-5959
Mailing Address - Street 1:PO BOX 19038
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-0038
Mailing Address - Country:US
Mailing Address - Phone:401-767-5959
Mailing Address - Fax:401-767-5957
Practice Address - Street 1:141 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4330
Practice Address - Country:US
Practice Address - Phone:401-767-5959
Practice Address - Fax:401-767-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI399251C00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAB70308Medicaid