Provider Demographics
NPI:1902085467
Name:GREATER RI ADDICTION SERVICES
Entity type:Organization
Organization Name:GREATER RI ADDICTION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADDICTIONS COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAINE
Authorized Official - Suffix:
Authorized Official - Credentials:BS,LCDP,RCS
Authorized Official - Phone:401-461-5555
Mailing Address - Street 1:1704 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2720
Mailing Address - Country:US
Mailing Address - Phone:401-461-5555
Mailing Address - Fax:401-461-5599
Practice Address - Street 1:1704 BROAD ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-2720
Practice Address - Country:US
Practice Address - Phone:401-461-5555
Practice Address - Fax:401-461-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty