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Organization

PROVIDENCE METRO TREATMENT CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. LARRY KACZMAREK (CONTROLLER)
(407) 351-7080
Entity
Organization

Contact information

Practice address
160 NARRAGANSETT AVE, PROVIDENCE, RI 02907-3367
(401) 941-4488
(401) 941-9797
Mailing address
14050 TOWN LOOP BLVD, SUITE 204, ORLANDO, FL 32837-6190
(407) 351-7080
(407) 351-6930

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
614, 614.1
RI
3336C0002X
Clinic Pharmacy
CMC00033
RI

Other

Enumeration date
05/11/2007
Last updated
12/03/2007
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