Provider Demographics
NPI:1801951397
Name:NORTHWEST COMMUNITY HEALTH CARE
Entity type:Organization
Organization Name:NORTHWEST COMMUNITY HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:401-285-5119
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859
Mailing Address - Country:US
Mailing Address - Phone:401-568-7664
Mailing Address - Fax:401-285-5101
Practice Address - Street 1:308 CALLAHAN RD
Practice Address - Street 2:
Practice Address - City:N. KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-7739
Practice Address - Country:US
Practice Address - Phone:401-295-9706
Practice Address - Fax:401-295-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIACF01530261QC1500X
RIACF01597261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINC50602Medicaid
RIBS41305Medicaid
RIBS41307Medicaid
RI411816Medicare PIN