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Organization
NICKERSON COMMUNITY CENTER
Active
Organization
NICKERSON COMMUNITY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA D'AMBRA (EXECUTIVE DIRECTOR)
(401) 351-2241
Entity
Organization
Contact information
Practice address
97 DELAINE ST, PROVIDENCE, RI 02909-2726
(401) 383-5672
Mailing address
133 DELAINE ST, PROVIDENCE, RI 02909-2728
(401) 351-2241
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
10/15/2007
Last updated
10/15/2007
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