Provider Demographics
NPI:1801889035
Name:STATE OF RHODE ISLAND
Entity type:Organization
Organization Name:STATE OF RHODE ISLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-462-0660
Mailing Address - Street 1:PO BOX 8293
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-0293
Mailing Address - Country:US
Mailing Address - Phone:401-462-1405
Mailing Address - Fax:401-462-3555
Practice Address - Street 1:111 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3001
Practice Address - Country:US
Practice Address - Phone:401-462-1405
Practice Address - Fax:401-462-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHOS00102282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP00402578 001OtherMEDICARE CHOICE
RI00004102001OtherHEALTHMATE 2000
RI000000 2900-001OtherBLUE SHIELD & PLAN 65
RI0000000027OtherBLUE CROSS PLAN 65
RI4102001Medicaid
RI53-09425OtherUNITED HEALTH CARE
RIRI22693OtherRI MED CTR PHY GROUP
CP00402578 001OtherMEDICARE + CHOICE
CP00402578 001OtherMEDICARE + CHOICE