Organization
ILLUMINATE LIFE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE KINSELLA (MANAGER)
(401) 542-9080
Entity
Organization
Contact information
Practice address
126 PAWTUXET TER, WEST WARWICK, RI 02893-5212
(401) 542-9080
Mailing address
126 PAWTUXET TER, WEST WARWICK, RI 02893-5212
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2021
Last updated
03/04/2021
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