Provider Demographics
NPI:1912328600
Name:TRI-COUNTY COMMUNITY ACTION AGENCY
Entity Type:Organization
Organization Name:TRI-COUNTY COMMUNITY ACTION AGENCY
Other - Org Name:TRI-COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-519-1967
Mailing Address - Street 1:1126 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7109
Mailing Address - Country:US
Mailing Address - Phone:401-351-2750
Mailing Address - Fax:401-351-6611
Practice Address - Street 1:33 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2415
Practice Address - Country:US
Practice Address - Phone:401-351-2750
Practice Address - Fax:401-351-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)