Basic Information
Provider Information
NPI: 1003005141
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOMAN
FirstName: SHARON
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25 RAILROAD AVE
Address2: P.O. BOX 226
City: WARREN
State: RI
PostalCode: 028853206
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 25 RAILROAD AVE
Address2:  
City: WARREN
State: RI
PostalCode: 028853206
CountryCode: US
TelephoneNumber: 4012474278
FaxNumber: 4012474569
Other Information
ProviderEnumerationDate: 10/15/2007
LastUpdateDate: 10/15/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
320800000XRN37196RIY Residential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness 

No ID Information.


Home