Provider Demographics
NPI:1871780908
Name:IRIE TRANSITIONAL PROGRAM
Entity type:Organization
Organization Name:IRIE TRANSITIONAL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:TUMMINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:401-497-8109
Mailing Address - Street 1:55 S BROW ST
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4433
Mailing Address - Country:US
Mailing Address - Phone:401-497-8109
Mailing Address - Fax:401-349-5160
Practice Address - Street 1:55 S BROW ST
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4433
Practice Address - Country:US
Practice Address - Phone:401-497-8109
Practice Address - Fax:401-349-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI251S00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health