Provider Demographics
NPI:1295944551
Name:OCEAN STATE CENTER FOR INDEPENDENT LIVING
Entity type:Organization
Organization Name:OCEAN STATE CENTER FOR INDEPENDENT LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-738-1013
Mailing Address - Street 1:1944 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-2448
Mailing Address - Country:US
Mailing Address - Phone:401-738-1013
Mailing Address - Fax:401-738-1083
Practice Address - Street 1:1944 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-2448
Practice Address - Country:US
Practice Address - Phone:401-738-1013
Practice Address - Fax:401-738-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOS55524Other057 WAIVER