Provider Demographics
NPI:1396780086
Name:TRI-COUNTY COMMUNITY ACTION AGENCY
Entity type:Organization
Organization Name:TRI-COUNTY COMMUNITY ACTION AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-519-1967
Mailing Address - Street 1:1126 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7130
Mailing Address - Country:US
Mailing Address - Phone:401-351-2750
Mailing Address - Fax:401-351-6613
Practice Address - Street 1:1126 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7130
Practice Address - Country:US
Practice Address - Phone:401-351-2750
Practice Address - Fax:401-351-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QD0000X, 261QS0112X
RIACF01507261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251S00000XAgenciesCommunity/Behavioral Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITT02485Medicaid
RI41-1812Medicare ID - Type UnspecifiedFQHC MEDICARE (UGS)
RI709000448Medicare PIN
RI709000448Medicare PIN