Provider Demographics
NPI:1487916136
Name:EAST BAY COMMUNITY ACTION PROGRAM
Entity type:Organization
Organization Name:EAST BAY COMMUNITY ACTION PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RILWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEYISITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-437-1008
Mailing Address - Street 1:100 BULLOCKS POINT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-437-1008
Mailing Address - Fax:401-433-3042
Practice Address - Street 1:610 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1504
Practice Address - Country:US
Practice Address - Phone:401-437-1008
Practice Address - Fax:401-433-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
RI251S00000X, 261QR0405X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIEA1247Medicaid