# PROSPECT CHARTERCARE SJHSRI, LLC

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

## Provider details

- **NPI number:** 1821656034
- **Authorized official:** ROBERT JON ELDERS (SECRETARY)
- **Authorized official phone:** (714) 788-1249

## Contact information

- **Practice address:** 200 HIGH SERVICE AVE, N PROVIDENCE, RI 02904-5113
- **Practice address phone:** (310) 943-4500
- **Mailing address:** 200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
- **Mailing address phone:** (310) 943-4500

## 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:** 06/03/2019
- **Last updated:** 01/15/2021