# PROSPECT CHARTERCARE RWMC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760977136
- **Authorized official:** ROBERT JON ELDERS (SECRETARY)
- **Authorized official phone:** (714) 788-1249

## Contact information

- **Practice address:** 825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
- **Practice address phone:** (401) 456-2000
- **Practice address fax:** (401) 456-2029
- **Mailing address:** 825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
- **Mailing address phone:** (401) 456-2000
- **Mailing address fax:** (401) 456-2029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/27/2018
- **Last updated:** 01/11/2021