Provider Demographics
NPI:1215152780
Name:SOUTH COUNTY COMMUNITY ACTION
Entity type:Organization
Organization Name:SOUTH COUNTY COMMUNITY ACTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-789-3016
Mailing Address - Street 1:1935 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-1616
Mailing Address - Country:US
Mailing Address - Phone:401-789-3016
Mailing Address - Fax:401-515-0139
Practice Address - Street 1:1935 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-1616
Practice Address - Country:US
Practice Address - Phone:401-789-3016
Practice Address - Fax:401-515-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management