Organization
PROSPECT CHARTERCARE SJHSRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JON ELDERS (SECRETARY)
(714) 788-1249
Entity
Organization
Contact information
Practice address
200 HIGH SERVICE AVE, N PROVIDENCE, RI 02904-5113
(310) 943-4500
Mailing address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
(310) 943-4500
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
06/03/2019
Last updated
01/15/2021
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