Provider Demographics
NPI:1417142761
Name:EASTER SEALS RHODE ISLAND
Entity type:Organization
Organization Name:EASTER SEALS RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-727-4270
Mailing Address - Street 1:633 THIRD AVENUE 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6701
Mailing Address - Country:US
Mailing Address - Phone:212-727-4270
Mailing Address - Fax:212-727-4374
Practice Address - Street 1:320 PHILLIPS ST
Practice Address - Street 2:UNIT 103
Practice Address - City:NORTH KINGTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5149
Practice Address - Country:US
Practice Address - Phone:401-284-1000
Practice Address - Fax:401-284-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIES59506Medicaid
RI3711A 31611OtherNEIGHBORHOOD HEALTH PLAN
RIES76201Medicaid
RIES68496Medicaid
RI413366OtherBLUE CHIP
RI33052-9OtherBLUE CROSS RHODE ISLAND