Organization
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Active
Other names
East Wallum Lake Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER RAE WHITE (DEPUTY CFO)
(401) 462-1343
Entity
Organization
Contact information
Practice address
1710 EAST WALLUM LAKE ROAD, PASCOAG, RI 02859-1825
(401) 567-0990
Mailing address
1710 E WALLUM LAKE RD, PASCOAG, RI 02859-1825
(401) 567-0990
(401) 567-0147
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
48
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EW12083
—
RI
Enumeration date
02/20/2007
Last updated
08/22/2019
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