Provider Demographics
NPI:1669517017
Name:TOWN OF SOUTH KINGSTOWN, RI
Entity type:Organization
Organization Name:TOWN OF SOUTH KINGSTOWN, RI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TOWN MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALFRED
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:401-789-9331
Mailing Address - Street 1:180 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3140
Mailing Address - Country:US
Mailing Address - Phone:401-789-9331
Mailing Address - Fax:401-789-5280
Practice Address - Street 1:283 POST RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-7507
Practice Address - Country:US
Practice Address - Phone:401-783-8736
Practice Address - Fax:401-792-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI12261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISK04307Medicaid