NPIMap

Organization Active NPI

Greater Providence Chapter,Riarc

  • Intellectual Disabilities Intermediate Care Facility
  • Providence, RI
National Provider Identifier
1124144928
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
91 Issued in RI
Legal business name
GREATER PROVIDENCE CHAPTER,RIARC
Practice address
40 Leander St
Providence, RI 02909-5636
Phone
(401) 272-3162
Fax
(401) 353-0290
NPI assigned
Mar 22, 2007
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
Mr. John Costa, BS, CPP
Title
Controller
Phone
(401) 353-6990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 91 RI Primary

Addresses

Primary practice location

40 Leander St
Providence, RI 02909-5636

Mailing address

220 Woonasquatucket Ave
North Providence, RI 02911-3196
Phone (401) 353-6990

Other identifiers 1

IdentifierTypeStateIssuer
JF02837MedicaidRI

Other names 1

  • JOHN E. FOGARTY CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Greater Providence Chapterriarc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124144928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 WOONASQUATUCKET AVE",
            "city": "NORTH PROVIDENCE",
            "state": "RI",
            "postal_code": "029113196",
            "telephone_number": "401-353-6990",
            "fax_number": "401-353-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 LEANDER ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029095636",
            "telephone_number": "401-272-3162",
            "fax_number": "401-353-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PROVIDENCE CHAPTER,RIARC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "401-353-6990",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS, CPP"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "RI",
            "license": "91",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "JF02837",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JOHN E. FOGARTY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, 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.