Basic Information
| Provider Information | |||||||||
| NPI: | 1356516439 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST BAY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 OLD COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | BARRINGTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028061602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012461195 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 OLD COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | BARRINGTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028061602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012461195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | CROSSLEY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4014378844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 623 | RI | Y | Agencies | Community/Behavioral Health |
No ID Information.