Provider Demographics
NPI:1336435031
Name:WEST BAY RESIDENTIAL SERVICES INC.
Entity Type:Organization
Organization Name:WEST BAY RESIDENTIAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-738-9300
Mailing Address - Street 1:158 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1225
Mailing Address - Country:US
Mailing Address - Phone:401-738-9300
Mailing Address - Fax:401-738-2787
Practice Address - Street 1:158 KNIGHT ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1225
Practice Address - Country:US
Practice Address - Phone:401-738-9300
Practice Address - Fax:401-738-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI215251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIWB55241Medicaid