Provider Demographics
NPI:1972975845
Name:BAXTER BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:BAXTER BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:NP
Authorized Official - Phone:401-829-6561
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-0610
Mailing Address - Country:US
Mailing Address - Phone:401-267-4485
Mailing Address - Fax:401-267-4534
Practice Address - Street 1:1130 TEN ROD RD STE D102
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4167
Practice Address - Country:US
Practice Address - Phone:401-267-4485
Practice Address - Fax:401-267-4534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37892363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1972975485Medicaid