Organization
NORTHWEST COMMUNITY HEALTH CARE
Active
Other names
WellOne Primary Medical and Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J BANCROFT (PRESIDENT & CEO)
(401) 285-5119
Entity
Organization
Contact information
Practice address
142A DANIELSON PIKE, FOSTER, RI 02825-1475
(401) 647-3702
(401) 647-5380
Mailing address
PO BOX 312, PASCOAG, RI 02859
(401) 568-7664
(401) 285-5101
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NC50602
—
RI
Enumeration date
08/01/2008
Last updated
10/21/2011
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