Organization
GREATER PROVIDENCE CHAPTER, RIARC
Active
Other names
John E. Fogarty Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R. COSTA BS, CPP (CONTROLLER)
(401) 353-6990
Entity
Organization
Contact information
Practice address
120 ANGELL RD, LINCOLN, RI 02865-4709
(401) 725-7710
(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
82
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JF02826
—
RI
Enumeration date
03/22/2007
Last updated
08/22/2020
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