Provider Demographics
NPI:1053538041
Name:COMMUNITY LIVING OF RHODE ISLAND
Entity type:Organization
Organization Name:COMMUNITY LIVING OF RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:ONYEJOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-739-9006
Mailing Address - Street 1:349 CENTERVILLE ROAD BLDG 6
Mailing Address - Street 2:BLDG 6
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-739-9006
Mailing Address - Fax:401-739-6009
Practice Address - Street 1:349 CENTERVILLE ROAD BLDG 6
Practice Address - Street 2:BLDG 6
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-739-9006
Practice Address - Fax:401-739-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI330251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICL54941Medicaid