Provider Demographics
NPI:1255549838
Name:DEPARTMENT OF HUMAN SERVICES
Entity type:Organization
Organization Name:DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CRC
Authorized Official - Phone:401-222-2300
Mailing Address - Street 1:40 FOUNTAIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1830
Mailing Address - Country:US
Mailing Address - Phone:401-222-2300
Mailing Address - Fax:401-222-1328
Practice Address - Street 1:40 FOUNTAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1830
Practice Address - Country:US
Practice Address - Phone:401-222-2300
Practice Address - Fax:401-222-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIEXEMPT FROM LICENSE251B00000X, 251K00000X
LICENSE NOT NEEDED332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOR07163Medicaid
RIOS63933Medicaid