NPIMap

Organization Active NPI

Carolina Back Road Group Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Charlestown, RI
National Provider Identifier
1205971983
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
263 Issued in RI
Legal business name
CAROLINA BACK ROAD GROUP HOME
Practice address
87 Carolina Back Rd
Charlestown, RI 02813-3602
Phone
(401) 364-1081
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 263 RI Primary

Addresses

Primary practice location

87 Carolina Back Rd
Charlestown, RI 02813-3602

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Spring Street Group Home65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

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": "1205971983",
    "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": "87 CAROLINA BACK RD",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028133602",
            "telephone_number": "401-364-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA BACK ROAD 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": "263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlestown, 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.