The Providence Community Health Centers, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Providence, RI
NPI 1174576342 · NPPES record last updated Dec 5, 2024
Key facts
- NPI
- 1174576342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.
- Practice address
- 1 Warren Way
Providence, RI 02905-5000 - Phone
- (401) 444-0530
- Fax
- (401) 444-0423
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Kevin Cabral
- Title
- Cfo
- Phone
- (401) 444-0400
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 8
Practitioners 91
-
Diana M. Afonso, PA
-
Mofoluso O Agbelese, DNP
-
Myah Audette, NP
-
Stephanie J Avila, CNM, NP-C
-
Mason C. Bandy, MD
-
Ida M. Bernstein, MD
-
Dianne M. Black, DNP
-
Stanley H. Block, MD
-
Allison J. Burch, NP
-
Nicole A. Curreri, DPM
-
Anh-Tai V. Dang, M.D.
-
Marisa Dasilva, DNP
-
Jenny R David, DO
-
Maria Fam, MD
-
Natalie A. Fealy, NP
-
Ellen Ficks, NP
-
Libertad T Flores, MD, MPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
Federally qualified health center certification: CCN 411837
- Legal name
- THE PROVIDENCE COMMUNITY HEALTH CENTERS INC.
- Doing business as
- CHAFEE HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 3, 2006
- Last certification
- Nov 3, 2006
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 1, 1976 in RI
- Enrollment address
- 1 Warren Way
Providence, RI 29055000
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia Harmon |
Corporate Director |
Jan 25, 2024 | |
| Brenda L Charpentier |
W-2 Managing Employee |
Jun 1, 2020 | |
| Michael Cancilliere |
Corporate Director |
Jan 1, 2015 | |
| Christina Zanfagna |
Corporate Director |
Jan 1, 1998 | |
| Meghan Hopkins |
Corporate Director |
Nov 16, 2023 | |
| Wendy Thomas |
Corporate Director |
Jan 1, 2014 | |
| Cassandra L Feeney |
Corporate Director |
Jan 1, 2016 | |
| Benjamin Miccinello |
Corporate Director |
Jan 27, 2025 | |
| Wilson O. Villamar |
Corporate Director |
Mar 1, 2025 | |
| J. Russell Corcoran |
Corporate Director |
Jan 1, 2022 | |
| Patti Osborne |
Corporate Director |
Jan 27, 2025 | |
| Merrill Thomas |
Corporate Officer |
Jun 30, 1997 | |
| W-2 Managing Employee |
Dec 12, 2003 | ||
| Rafael Yepez |
Corporate Director |
Sep 28, 2023 | |
| Joseph Espat |
Corporate Director |
Mar 17, 2023 | |
| Kevin J Cabral |
Corporate Officer |
Jun 1, 2020 | |
| Amber Bichun |
Corporate Director |
Oct 1, 2019 | |
| Byron Monge |
Corporate Director |
Aug 31, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060911000247 | RI | Part a Provider - Federally Qualified Health Center (FQHC) | 9335050962 | Practice locations: Providence, RI |
National Provider Directory
- Tax ID family
- The Providence Community Health Centers Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1 Warren Way
Providence, RI 02905-5000
Mailing address
375 Allens Ave
Providence, RI 02905-5010
Phone (401) 444-0400
Other names
- Chafee Health Center
Other providers in Providence, RI
- The Providence Community Health Centers Inc.
- The Providence Community Health Centers, Inc
- The Providence Community Health Centers, Inc
- The Providence Community Health Centers, Inc
- The Providence Community Health Centers, Inc
- The Providence Community Health Centers, Inc.
- The Providence Community Health Centers, Inc.
- The Providence Community Health Centers, Inc.
- The Providence Community Health Centers, Inc.
- The Providence Community Health Centers, Inc.
All providers in Providence, RI · Federally Qualified Health Center (FQHC) in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.