Provider Demographics
NPI:1083690044
Name:PACE ORGANIZATION OF RHODE ISLAND
Entity type:Organization
Organization Name:PACE ORGANIZATION OF RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MCANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-434-1400
Mailing Address - Street 1:10 TRIPPS LANE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-654-4789
Mailing Address - Fax:401-654-4660
Practice Address - Street 1:10 TRIPPS LANE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-654-4789
Practice Address - Fax:401-654-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 261QA0600X
RI19302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H4105OtherPACE DHS CONTRACT #