Provider Demographics
NPI:1851126288
Name:BRAIN INJURY ASSOCIATION OF RHODE ISLAND
Entity type:Organization
Organization Name:BRAIN INJURY ASSOCIATION OF RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESOURCE FACILITATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCINI TEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-228-3319
Mailing Address - Street 1:1029 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1314
Mailing Address - Country:US
Mailing Address - Phone:401-228-3319
Mailing Address - Fax:
Practice Address - Street 1:1029 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1314
Practice Address - Country:US
Practice Address - Phone:401-228-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health