Prospect Chartercare RWMC, LLC
Organization Active NPI Addiction Medicine (Internal Medicine) Physician · Providence, RI
NPI 1760977136 · NPPES record last updated Jan 11, 2021
Key facts
- NPI
- 1760977136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction Medicine (Internal Medicine) Physician 207RA0401X
- Legal business name
- PROSPECT CHARTERCARE RWMC, LLC
- Practice address
- 825 Chalkstone Ave
Providence, RI 02908-4728 - Phone
- (401) 456-2000
- Fax
- (401) 456-2029
- NPI assigned
- Jun 27, 2018
- Organization subpart
- No
Authorized official
- Name
- Robert Jon Elders
- Title
- Secretary
- Phone
- (714) 788-1249
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Internal Medicine) Physician |
207RA0401X | Yes |
Addresses
Primary practice location
825 Chalkstone Ave
Providence, RI 02908-4728
Mailing address
825 Chalkstone Ave
Providence, RI 02908-4728
Phone (401) 456-2000
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.