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Carolina Back Road Group Home

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Charlestown, RI

NPI 1205971983 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1205971983
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
License
263 (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
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

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

National Provider Directory

Tax ID family
University of Rhode Island (65 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 263 RI Yes

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

Other identifiers

IdentifierTypeStateIssuer
LC01932MedicaidRI

Other providers in Charlestown, RI

All providers in Charlestown, RI · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Rhode Island

Sources for this page

Verify at the official NPI Registry.