Organization
STATE OF RHODE ISLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD R CHAREST (DIRECTOR)
(401) 462-0660
Entity
Organization
Contact information
Practice address
111 HOWARD AVE, CRANSTON, RI 02920-3001
(401) 462-1405
Mailing address
PO BOX 8293, CRANSTON, RI 02920-0293
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
HOS00102
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000 2900-001
BLUE SHIELD & PLAN 65
RI
01
—
0000000027
BLUE CROSS PLAN 65
RI
01
—
00004102001
HEALTHMATE 2000
RI
01
—
0000ZJY915
BLUE CROSS BLUE SHIELD MA
—
01
—
53-09425
UNITED HEALTH CARE
RI
01
—
CP00402578 001
MEDICARE PLUS CHOICE
RI
01
—
RI22693
RI MEDICAL CENTER GENERAL HOSPITAL PHYSICIAN GROUP
RI
Enumeration date
10/12/2006
Last updated
09/02/2022
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