Provider Demographics
NPI:1700902392
Name:AIDS CARE OCEAN STATE, INC.
Entity Type:Organization
Organization Name:AIDS CARE OCEAN STATE, INC.
Other - Org Name:SUNRISE COMMUNITY HOUSING, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-521-3603
Mailing Address - Street 1:18 PARKIS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1454
Mailing Address - Country:US
Mailing Address - Phone:401-521-3603
Mailing Address - Fax:401-861-2981
Practice Address - Street 1:557 BROAD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1403
Practice Address - Country:US
Practice Address - Phone:401-273-1888
Practice Address - Fax:401-454-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
RI46853322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1700902392Medicaid