NPIMap

Organization Active NPI

Tri-County Community Action Agency

Doing business as Tri-County Health Center

  • Federally Qualified Health Center (FQHC)
  • North Providence, RI
National Provider Identifier
1912328600
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI-COUNTY COMMUNITY ACTION AGENCY
Doing business as
Tri-County Health Center
Tri-Town Community Health Center of North Providence
Practice address
33 Maple St
North Providence, RI 02911-2415
Phone
(401) 351-2750
Fax
(401) 351-6611
NPI assigned
Dec 23, 2013
Last updated
Jun 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Joseph R. Desantis
Title
Chief Executive Officer
Phone
(401) 519-1967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X RI Primary

Addresses

Primary practice location

33 Maple St
North Providence, RI 02911-2415

Mailing address

1126 Hartford Ave
Johnston, RI 02919-7109
Phone (401) 351-2750

Other names 2

  • Tri-County Health Center Doing business as
  • Tri-Town Community Health Center of North Providence Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140403000221 RI Part A Provider - Federally Qualified Health Center (FQHC) 0648171181 Practice locations: North Providence, RI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912328600. Details of each certification follow.

Federally qualified health center certification: CCN 411847

Legal name
TRI-COUNTY COMMUNITY ACTION AGENCY
Doing business as
TRI-COUNTY COMMUNITY HEALTH CENTER OF NORTH PROVIDENCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2015
Last certification
Jan 9, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Oct 14, 1966 in RI
Enrollment address
33 Maple St
North Providence, RI 29112415

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Tri-County Community Action16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tri-County Community Action Agency Organization, Johnston, RI Non-profit 5% Or Greater Security Interest Jun 1, 2013 100%
Saikon Gbehan Individual Corporate OfficerBoard of Directors Dec 1, 2013 5%
Richard Delfino Individual Corporate OfficerBoard of Directors Oct 1, 1997 5%
Raymond Pingitore Individual Corporate OfficerBoard of Directors May 22, 2007 5%
Craig Levis Individual Corporate OfficerBoard of Directors Jan 1, 2007 5%
Samuel Limiadi Individual Corporate OfficerCfo Sep 5, 2013 5%
Joseph R Desantis Individual Corporate OfficerChief Executive Officer May 1, 2014 100%
W-2 Managing EmployeeCeo Mar 10, 1973 100%
Robert O'Brien Individual Corporate OfficerBoard of Directors Jan 1, 1994 5%
Cheryl Jackson Individual Corporate OfficerBoard of Directors Mar 1, 1995 5%
Ben Zanni Individual Corporate OfficerBoard of Directors May 1, 2001 5%
Paul Macdonald Individual Corporate OfficerBoard of Directors Sep 1, 2010 5%
Paul Gott Individual Corporate OfficerBoard of Directors Nov 1, 2010 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1912328600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 HARTFORD AVE",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029197109",
            "telephone_number": "401-351-2750",
            "fax_number": "401-351-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MAPLE ST",
            "city": "NORTH PROVIDENCE",
            "state": "RI",
            "postal_code": "029112415",
            "telephone_number": "401-351-2750",
            "fax_number": "401-351-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY COMMUNITY ACTION AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-23",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "DESANTIS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "401-519-1967",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "RI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-County Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tri-Town Community Health Center of North Providence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Providence, RI

Sources for this page

Verify at the official NPI Registry.