Provider Demographics
NPI:1871079863
Name:EASTER SEALS RHODE ISLAND
Entity type:Organization
Organization Name:EASTER SEALS RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO-ESCT
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-615-6811
Mailing Address - Street 1:633 THIRD AVEUNE 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6701
Mailing Address - Country:US
Mailing Address - Phone:212-727-4300
Mailing Address - Fax:
Practice Address - Street 1:662 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-5917
Practice Address - Country:US
Practice Address - Phone:401-854-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI848.00385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child