Provider Demographics
NPI:1669428348
Name:EAST BAY CENTER, INC.
Entity type:Organization
Organization Name:EAST BAY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICERF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROSSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-437-8844
Mailing Address - Street 1:2 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1602
Mailing Address - Country:US
Mailing Address - Phone:401-437-8844
Mailing Address - Fax:401-437-8847
Practice Address - Street 1:2 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1602
Practice Address - Country:US
Practice Address - Phone:401-437-8844
Practice Address - Fax:401-437-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI623261QM0801X, 261QR0405X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29206-5OtherBCBSRI
RI23501OtherUBH
RIBCG0001107OtherBCBSRI
RICPG0001107OtherBCBSRI
RI1016900OtherNHPRI
RI900-1872Medicaid
RI30738-9OtherBCBSRI
RI408215OtherBCBSRI
RI410862OtherBCBSRI
RI412121OtherBCBSRI
RI84-60036OtherUBH
RIEB02290Medicaid
RI6963OtherBCBSRI
RI23501OtherUBH