| Prospect Chartercare Sjhsri, Llc | |
|
200 High Service Ave North Providence RI 02904-5113 | |
| (401) 456-3000 | |
| (401) 456-3028 |
| Full Name | Prospect Chartercare Sjhsri, Llc |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 200 High Service Ave, North Providence, Rhode Island |
| Authorized Official Name and Position | Robert Jon Elders (SECRETARY) |
| Authorized Official Contact | 7147881249 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospect Chartercare Sjhsri, Llc 200 High Service Ave North Providence RI 02904-5113 Ph: (401) 456-3000 | Prospect Chartercare Sjhsri, Llc 200 High Service Ave North Providence RI 02904-5113 Ph: (401) 456-3000 |
| NPI Number | 1396160396 |
|---|---|
| Provider Enumeration Date | 02/27/2014 |
| Last Update Date | 01/15/2021 |
| Certification Date | 01/15/2021 |
| Medicare PECOS PAC ID | 7315179314 |
|---|---|
| Medicare Enrollment ID | O20140404001743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396160396 | NPI | - | NPPES |
| 41S0005 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | HOS00110 (Rhode Island) | Primary |
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