Provider Demographics
NPI:1992569388
Name:THE STATE OF RHODE ISLAND
Entity type:Organization
Organization Name:THE STATE OF RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-BHDDH
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CERBO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:401-462-0917
Mailing Address - Street 1:45 HOWARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-462-2780
Mailing Address - Fax:401-462-4052
Practice Address - Street 1:45 HOWARD AVENUE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-462-2780
Practice Address - Fax:401-462-4052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE STATE OF RHODE ISLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital