Basic Information
| Provider Information | |||||||||
| NPI: | 1982878930 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY CARE ALLIANCE EARLY INTERVENTION | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1700 | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028950856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012357000 | ||||||||
| FaxNumber: | 4017674075 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028953123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012357000 | ||||||||
| FaxNumber: | 4017674075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2008 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | MAGAW | ||||||||
| AuthorizedOfficialFirstName: | DARLENE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, EARLY INTERVENTION | ||||||||
| AuthorizedOfficialTelephone: | 4012356015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY CARE ALLIANCE | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.