Organization
GREATER PROVIDENCE CHAPTER,RIARC
Active
Other names
JOHN E. FOGARTY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN COSTA BS,CPP (CONTROLLER)
(401) 353-6990
Entity
Organization
Contact information
Practice address
109 SHERWOOD ST, PROVIDENCE, RI 02908-1617
(401) 273-7090
(401) 353-0290
Mailing address
220 WOONASQUATUCKET AVE, NORTH PROVIDENCE, RI 02911-3196
(401) 353-6990
(401) 353-0290
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
140
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JF02848
—
RI
Enumeration date
03/22/2007
Last updated
08/22/2020
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