Basic Information
| Provider Information | |||||||||
| NPI: | 1437191061 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY CARE ALLIANCE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FORMERLY NRI COMMUNITY SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1700 | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028950856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012357000 | ||||||||
| FaxNumber: | 4017679177 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 CLINTON ST | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028953245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012357000 | ||||||||
| FaxNumber: | 4017679177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LESSING | ||||||||
| AuthorizedOfficialFirstName: | BENEDICT | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4012357000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | RI | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 175T00000X | N | 193200000X MULTI-SPECIALTY GROUP | 225400000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 251300000X | N | Agencies | Local Education Agency (LEA) | 251B00000X | N | Agencies | Case Management | 251K00000X | N | Agencies | Public Health or Welfare | 261QM0801X | 627 | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QR0405X | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 310400000X | RI | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 322D00000X | RI | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 405300000X | N | 193200000X MULTI-SPECIALTY GROUP | 251S00000X | RI | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | NR02178 | 05 | RI | MEDICAID | NR02172 | 05 | RI | MEDICAID | NR14021 | 05 | RI | MEDICAID | 69250 | 01 | RI | BLUE CROSS SA | OTHER | CP00408220 | 01 | RI | BCHIP SA | OTHER | CR32696 | 05 | RI | MEDICAID | 259109 | 01 | RI | BC MA | OTHER | 1021720 | 01 | RI | UBH | OTHER |