NPIMap

Organization Active NPI

Coolidge Avenue Group Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Woonsocket, RI
National Provider Identifier
1083749246
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
152 Issued in RI
Legal business name
COOLIDGE AVENUE GROUP HOME
Practice address
225 Coolidge Ave
Woonsocket, RI 02895-2309
Phone
(401) 766-7955
NPI assigned
Feb 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Ellen R Nelson
Title
Director
Phone
(401) 462-6001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 152 RI Primary

Addresses

Primary practice location

225 Coolidge Ave
Woonsocket, RI 02895-2309

Mailing address

6 Harrington Rd
Cranston, RI 02920-3080
Phone (401) 462-2659

Other identifiers 1

IdentifierTypeStateIssuer
LC01912MedicaidRI

National Provider Directory

National Provider Directory
Tax ID family
Refern Grove Apartments65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083749246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 HARRINGTON RD",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029203080",
            "telephone_number": "401-462-2659",
            "fax_number": "401-462-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 COOLIDGE AVE",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028952309",
            "telephone_number": "401-766-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOLIDGE AVENUE GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "401-462-6001",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "RI",
            "license": "152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LC01912",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woonsocket, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.