The Providence Community Health Centers, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Providence, RI
NPI 1891775128 · NPPES record last updated Dec 5, 2024
Key facts
- NPI
- 1891775128
- 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
- 375 Allens Ave
Providence, RI 02905-5010 - Phone
- (401) 444-0400
- Fax
- (401) 444-0468
- NPI assigned
- Jan 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Kevin Cabral
- Title
- Chief Financial Officer
- Phone
- (401) 444-0400
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in RI
Federally qualified health center certification: CCN 411801
- Legal name
- THE PROVIDENCE COMMUNITY HEALTH CENTERS INC.
- Doing business as
- PRAIRE AVENUE HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 1, 1976 in RI
- Enrollment address
- 355 Prairie Ave
Providence, RI 29051928
Federally qualified health center certification: CCN 411818
- Legal name
- THE PROVIDENCE COMMUNITY HEALTH CENTERS INC.
- Doing business as
- CAPITOL HILL HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 26, 2004
- Last certification
- Jan 26, 2004
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 1, 1976 in RI
- Enrollment address
- 40 Candace St
Providence, RI 29083747
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia Harmon |
Corporate Director |
Jan 25, 2024 | |
| 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, 2010 | |
| 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 Director |
Nov 3, 2003 | |
| W-2 Managing Employee |
Nov 3, 2003 | ||
| Corporate Officer |
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 |
|---|---|---|---|---|
| O20030812000060 | RI | Part a Provider - Federally Qualified Health Center (FQHC) | 9335050962 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Providence, RI |
| O20030812000063 | RI | Part a Provider - Federally Qualified Health Center (FQHC) | 9335050962 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Providence, RI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
375 Allens Ave
Providence, RI 02905-5010
Mailing address
375 Allens Ave
Providence, RI 02905-5010
Phone (401) 444-0400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7001361 | Medicaid | RI |
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 Rhode Island Coalition for the Homeless, Inc.
- The Rhode Island Nursing Middle College Charter School
- The Rhode Island Public Health Foundation
- The Serenity Stars
- The Stop & Shop Supermarket Company LLC
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.